MEMBER SERVICES REPRESENTATIVE I
The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time Member Services Representative. Under close supervision will provide customer and support services to members of the Health Plan of San Mateo (HPSM) in Medi-Cal, Healthy Kids, HealthWorx and San Mateo County ACE Program.
The essential duties and responsibilities will include the following:
- Provide customer service to HPSM members/participants primarily on the phone.
- Answer member/participant questions and/or refer the member/participant to the appropriate outside agency.
- Educate members/participants about their rights and responsibilities.
- Explain the benefits of the program, how the plan works, and how to get care.
- Answer questions about provider network for appropriate product line.
- Process changes to member records such as primary care physician, demographic and other changes.
- Conduct welcome calls.
- Assist members in resolution of problems receiving covered services and complaints, in an effective, accurate and timely manner.
- Document all activities in HPSM System.
- Refer unresolved complaints to the Grievance and Appeals Unit.
- Prepare activity reports as required.
- Follow-up if member has selected a provider in Established Patient Only (EPO) status.
- Answer questions about providers; educate members on effective dates for PCP changes; assist members in selecting and changing their PCP.
- Participate in and professionally represent HPSM at health fairs, community partnerships, meetings, committees and coalitions as requested by the Manager or Supervisor.
- Work with entire Member Services department to continuously measure and improve the performance of the department and HPSM.
- Perform other duties as assigned
Education and Experience:
- Equivalent to a high school diploma or GED required
- One (1) year experience in a customer service environment highly desirable.
- Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access and PowerPoint.
- Health insurance programs preferred.
- Customer service principles and practices.
- Work cooperatively with others.
- Work as part of a team and support team decisions.
- Communicate effectively, both verbally and in writing.
- Adapt to changes in requirements/priorities for daily and specialized tasks
- Demonstrate excellent oral and written communication skills with various audiences and individuals of diverse backgrounds.
- Perform problem research, use analytical skills, and effectively influence positive outcomes.
- Develop and maintain strong professional relationships with a diverse range of people.
- Utilize a personal computer, including the range of Microsoft Office products (Word, Excel, PowerPoint, Access, and Outlook).
- Bilingual skills in Spanish, Tagalog, Mandarin, Cantonese, Russian, or Arabic.
Compensation and Benefits
Starting Compensation Range: - Depending on Experience
Benefits Information: Excellent benefits package offered, including HPSM paid premiums for employee’s Medical, Dental and Vision coverage. Employee pays a small portion of the dependent premiums (5%) for medical and dental benefits. Additional HPSM benefits include fully paid life, AD&D, and LTD insurance; retirement plan (HPSM contributes equivalent of 10% of annual compensation); holiday and vacation pay; tuition reimbursement plan; onsite fitness center and more.
How to Apply
Application Process: To apply, submit a resume and cover letter with salary expectations to: Health Plan of San Mateo, Human Resources Department, 801 Gateway Blvd., Suite 100, South San Francisco, CA 94080 or via email: email@example.com or via fax: (650) 616-8039. File by: Continuous until filled. The Health Plan of San Mateo is proud to be an Equal Opportunity Employer and encourages minority candidates of all backgrounds to apply.
Submissions without a Cover Letter and Salary Expectations may not be considered.