Member Service Representative

6 days ago


Orange, United States Astiva Health, Inc Full time

Job Title: Member Service Representative (Bilingual - Vietnamese, Korean, Spanish, or Chinese)

Target Compensation Range: $20.00-$25.00/hour, depending on the level of relevant qualifications and experience.


About Us:

Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize accessibility, affordability, and quality in all aspects of our services. Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members.


SUMMARY: The Member Service Specialist is responsible for answering telephonic inquiries from current and potential members and providers regarding Medicare Advantage benefits, eligibility, enrollment, claims, referral, prior authorizations, appeals & grievances and other related concerns. Our Member Service Specialists ensure customer satisfaction by providing excellent customer service, displaying a desire to help and maintaining a professional demeanor. Member Service Specialists will be expected to maintain quality and performance standards.


ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:

  • Handle inbound and outbound phone calls, emails and other necessary communications with members and providers
  • Clearly identify and act on customer needs to achieve satisfaction.
  • Clearly explain all details of the Medicare Advantage Plan including procedures, protocols, benefits, and any other necessary information to the member or provider during inbound and outbound calls.
  • Fully understand all aspects of Medicare Advantage including but not limited to benefits, prior authorization, referrals, claims, enrollment, eligibility, appeals & grievances, providers networks and pharmacy services.
  • Provide accurate and complete information using the tools provided
  • Keep detailed written records of each telephone encounter during the call
  • Adhere to all call center metrics as set forth by CMS regulation and call center leadership.
  • Attempt to resolve the member’s issue completely during the first phone call.
  • Go above and beyond to provide exceptional customer service.


EDUCATION and/or EXPERIENCE:

  • 2+ years customer service experience
  • Minimum 1+ years’ experience with Medicare Advantage
  • Health Plan experience.
  • Excellent verbal and written communication skills including active listening and probing techniques.
  • Ability to multi-tasks, time manage and prioritize.
  • Ability to document information while on the phone with the member.
  • Ability to build rapport with members
  • Fluent in Spanish, Korean, Vietnamese, or Cantonese/Mandarin (verbal and written)


BENEFITS:

  • 401(k)
  • Dental Insurance
  • Health Insurance
  • Life Insurance
  • Vision Insurance
  • Paid Time Off


  • Orange, California, United States Alignment Healthcare Full time

    Job SummaryAlignment Healthcare is seeking a highly motivated and experienced Healthcare Operations Lead to join our Member Services team. As a key member of our operations team, you will be responsible for leading and managing a team of customer service representatives, ensuring exceptional member experience, and driving business growth.Key...


  • Orange, Texas, United States MCT Credit Union Full time

    Job DescriptionAt MCT Credit Union, we are seeking a highly skilled and customer-focused Member Service Representative/Lobby to join our team. As a key member of our branch staff, you will be responsible for providing exceptional service to our members, handling a variety of financial transactions, and maintaining accurate records.Key Responsibilities:Member...


  • Orange, United States Prospect Medical Full time

    The Member Relations Representative is responsible for acting as a liaison between members, health plans, and physicians. Individuals are required to perform at minimum 120 outbound attempts per day to Medi-Medi, Medicare, Commercial, POS and Medi-Cal members who are existing members with enrollment errors or are identified as potential terminations and...


  • Orange, United States Prospect Medical Full time

    The Member Relations Representative is responsible for acting as a liaison between members, health plans, and physicians. Individuals are required to perform at minimum 120 outbound attempts per day to Medi-Medi, Medicare, Commercial, POS and Medi-Cal members who are existing members with enrollment errors or are identified as potential terminations and...


  • Orange, United States Prospect Medical Full time

    The Member Relations Representative is responsible for acting as a liaison between members, health plans, and physicians. Individuals are required to perform at minimum 120 outbound attempts per day to Medi-Medi, Medicare, Commercial, POS and Medi-Cal members who are existing members with enrollment errors or are identified as potential terminations and...


  • Orange, United States Alta Hospitals Full time

    The Member Relations Representative is responsible for acting as a liaison between members, health plans, and physicians. Individuals are required to perform at minimum 120 outbound attempts per day to Medi-Medi, Medicare, Commercial, POS and Medi-Cal members who are existing members with enrollment errors or are identified as potential terminations and...


  • Orange, United States Alta Hospitals Full time

    The Member Relations Representative is responsible for acting as a liaison between members, health plans, and physicians. Individuals are required to perform at minimum 120 outbound attempts per day to Medi-Medi, Medicare, Commercial, POS and Medi-Cal members who are existing members with enrollment errors or are identified as potential terminations and...


  • Orange City, United States Fairwinds Full time

    ** Member Service Representative 1 - Orange City** **Job Category****:** Retail Banking **Requisition Number****:** MSR10001683 Showing 1 location **Job Details** **Description** ***Welcome to FAIRWINDS Credit Union, a company that was built upon the simple philosophy of people helping people since 1949. Helping our members achieve financial freedom, helping...


  • Orange Park, United States Crunch Fitness - Northeast Florida Full time

    Job DescriptionJob DescriptionReports to:Club ManagerRequirements:Fluent in English; bilingual in Spanish a plus!Proficient reading and writing skillsComputer SkillsSpecial Skills:Strong customer service skillsResponsibilities:Membership SalesGreet all members & guests with a smile and wish them well as they exit the clubCheck in all members and guests in...

  • Food Service Worker

    7 days ago


    Orange, California, United States Providence Service Full time

    Job SummaryWe are seeking a skilled Food Service Attendant to join our team at Providence Service. As a key member of our food service team, you will be responsible for providing exceptional customer service, preparing and serving food, and maintaining a clean and safe environment.Key ResponsibilitiesProvide prompt and courteous service to customers,...


  • Orange, United States Susie Kang - State Farm Agent Full time

    Job DescriptionJob DescriptionROLE DESCRIPTION:As a CUSTOMER SERVICE REPRESENTATIVE with SUSIE KANG STATE FARM INSURANCE AGENCY, you will generate the kind of exceptional client experiences that reinforce the growth of a successful insurance agency. Your attention to detail, customer service skills, and desire to help people make you an ideal fit. You will...


  • Orange, United States Susie Kang - State Farm Agent Full time $35,000 - $45,000

    Job DescriptionJob DescriptionBenefits:Bonus based on performanceCompetitive salaryOpportunity for advancementPaid time offROLE DESCRIPTION:As a CUSTOMER SERVICE REPRESENTATIVE with SUSIE KANG STATE FARM INSURANCE AGENCY, you will generate the kind of exceptional client experiences that reinforce the growth of a successful insurance agency. Your attention to...


  • Orange, United States Kevin Piscitelli - State Farm Agent Full time

    Job DescriptionJob DescriptionOUR AGENCYOur Agency prides ourselves on serving the needs of each customer. We are regularly recognized for providing outstanding service by our customers. We are a competitive team that strives to win and get better every day. We have been recognized with many State Farm awards. My personal goal is to coach and mentor each...


  • Orange, United States Astiva Health, Inc Full time

    Job Title: Member Service Representative (Bilingual - Vietnamese, Korean, Spanish, or Chinese)Target Compensation Range: $20.00-$25.00/hour, depending on the level of relevant qualifications and experience.About Us:Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering...


  • Orange, United States Maggie Garay - State Farm Agent Full time

    Job DescriptionJob DescriptionPosition OverviewSuccessful State Farm Agent is seeking a qualified professional to join their winning team for the role of Customer Service Representative - State Farm Agent Team Member. We seek an energetic professional interested in helping our business grow through value-based conversations and remarkable customer...


  • Orange, California, United States Truly Nolen Full time

    We are seeking a professional Customer Service Representative with patience, accountability, and a genuine passion for providing a quality customer experience. You also enjoy looking for sales opportunities. The Customer Service Representative is responsible for developing the relationships between our customers, service technicians, and operations. Looking...


  • Orange, California, United States Domino's Franchise Full time

    Job OverviewJoin Our Team! We are in search of enthusiastic individuals with excellent interpersonal skills to represent our organization.Key Responsibilities:Provide exceptional service to our customers.Assist in resolving inquiries and concerns efficiently.Collaborate with team members to enhance customer satisfaction.What We Offer:We provide numerous...


  • Orange, California, United States Domino's Franchise Full time

    Job OverviewWe are seeking a friendly and approachable individual to join our team as a Customer Service Representative. As a key member of our Domino's Franchise, you will be responsible for providing exceptional customer service and ensuring a positive experience for our customers.Key ResponsibilitiesProvide prompt and courteous service to customers via...


  • Orange, United States The Midtown Group Full time

    Our client, a well-respected California Based Healthcare Company, is seeking a team of Customer Service Representatives (Non-Bilingual) to join our team. The Customer Service Representative (CSR) will be the first line of contact for the organization's members and providers. The incumbent will assist members and providers with questions and/or complaints...

  • Team Member

    4 days ago


    Orange, California, United States Graffius Food Services, Inc Full time

    Job SummaryWe are seeking a highly motivated and customer-focused Team Member to join our Graffius Food Services, Inc. team. As a Team Member, you will be responsible for delivering exceptional guest experiences by providing excellent service, great tasting/quality food, and a clean restaurant environment.Key ResponsibilitiesGuest Service:Immediately...