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Member Services Representative I, South San Francisco, CA

Organization: Health Plan of San Mateo
Category: Professional
Location: South San Francisco, CA
Date Job Posted: March 4, 2020
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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.

Knowledge of:

  • 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.

Ability to:

  • 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: 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.

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