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Member Services Representative I

2 months ago

South San Francisco, United States Health Plan of San Mateo Full time

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.

Position overview
- 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.

**Requirements**:
These are the qualifications typically needed to succeed in this position. However, you don’t need to meet every requirement to apply.
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**:

- 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).

**Skills**:

- Bilingual skills in Spanish, Tagalog, Mandarin, or Cantonese.

Salary and benefits
**Time off**: 24 hours of time off per year.
It is HPSM's policy to provide equal employment opportunity for all applicants and employees. HPSM does not unlawfully discriminate based on race, religion, color, national origin, ancestry, physical disability, mental disability, medical condition, marital status, sex, age, sexual orientation, veteran status, registered domestic partner status, genetic information, gender, gender identity, gender expression, or any other characteristic protected by applicable federal, state, or local law. HPSM also prohibits discrimination based on the perception that an applicant or employee has any of those characteristics or is associated with a person who has or is perceived to have any of those characteristics.