Member Services Representatives - Medicare (Short Term Assignment)

What you can expect! 

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

Medicare Member Services Representative is responsible for being a devoted and compassionate advocate for Medi-Cal, Medi-Medi and Medicare Members when assisting with maximizing their benefits, navigating the healthcare system and reaching their optimal health. Using multiple complex systems, responsible for providing guidance and answering questions from Members about their benefits and medical claims, as well as educating Members about wellness programs. Assisting Members in assessing tools available to help guide decision-making about complex matters related to their wellbeing. Facilitate the Members selection and access to in-network healthcare providers. Collaborate with inter-departments to ensure Member needs are met.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

This is a short-term role with a duration of up to 6 months. Please note that this position is not eligible for benefits.

While there is a possibility that this role could lead to a permanent position, permanent employment is not guaranteed and will depend on business needs, performance, and other factors.

1. Handle Medi-Cal and Medicare Inbound Calls
   1. Responsible for covering the Cisco ACD Queue telephone lines.
   2. Meet IEHP and Member Services Call Center standard and policy requirements.
   3. Assist Members with many different process or benefit information such as:
      1. Members eligibility status
      2. Primary care/facility assignments, selections and changes
      3. Health program education
   4. Ensures documentation is accurate and in compliance with regulatory requirements and accreditation standards
   5. Maintain knowledge of other department’s roles as they pertain to Member Services standard work processes, to ensure proper handling of calls
   6. Ensure key performance indicator goals are met monthly (Quality Assurance, AHT, Adherence).
   7. Bilingual Position: Coordinate telephonic translation of calls when Members do not speak English or Spanish
2. Off phone work
   1. QA Review
   2. One on One
   3. Projects
   4. Meetings
3. Any other duties as required to ensure Health Plan operations are successful
4. Ensure the privacy and security of PHI (Protected Health Information) as outlined in IEHP's policies and procedures relating to HIPAA compliance

Education & Requirements 

• Experience Requirements:
  • Two (2) years of HMO or Manage Care customer service experience analyzing and solving customer problems
• High school diploma or GED required

This is a non-bilingual: bilingual highly preferred position. Identified bilingual team members in this role must take a language proficiency assessment and must receive a passing score.

Key Qualifications

• Knowledge of Medicare managed care is preferred
• Knowledge of Medical terminology, and Medi-Cal managed care is required
• Understanding of and sensitivity to multi-cultural community
• Proficiency in Microsoft Office Suite; high level capacity to multitask
• Excellent multi-tasking skills. Typing 35 words per minute, proficient in Windows applications, and experience in data entry
• Knowledgeable of with the following programs: Cisco Finesse, Verint, HSP, Microsoft
• Excellent written and verbal communication and interpersonal skills
• Strong organizational skills
• Ability and willingness to learn and follow direction in a fast-paced call center environment
• Ability and desire to handle 25-30 calls per day
• Adherence to specific work schedule is required
• Works well in a fast-paced environment
• Team culture a must
• Positive Attitude and ability to work in a team setting
• High level of patience
• Telephone courtesy
• Attention to detail
• Willingness and ability to learn
• Ability to work independently within specified time constraints
• Excellent punctuality and attendance required
• Ability to adapt and perform duties efficiently when unexpected changes arise
• This position will work non-traditional hours to achieve coverage during periods where training or extended call center operations are required
• Position is eligible for telecommuting/remote work location upon completing the necessary steps and receiving HR approval
• All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership

Start your journey towards a thriving future with IEHP and apply TODAY!

Telecommute (All IEHP positions approved for telecommute work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership)