Member Services

Orange, CA 92868

Employment Type: Contract Job Category: Medical Customer Service Job Number: 46333 Pay Rate: 17
Have a passion for people and healthcare? Would you like to work for a company in Orange that has a 30-year history of successfully supporting its members and management? Immediate openings available for Member Service Representatives to assist with open enrollment for Medicare Advantage based in their central Orange County office. Fun environment with staff events, employee performance recognition programs, promotion potential in a variety of departments, and amazing benefits!
Job Functions:
Acting as an Ambassador for company to their members and other callers
Answering customer service calls from members, providers, pharmacy, service representatives and staff members
Explaining the plans benefits, procedures and services for customer service calls
Providing providers and employers information for benefits and eligibility
Providing authorization for outpatient surgery or claims concerns for members
Providing referral requests to other providers who are part of network
Processing hospital admission and pre-admit authorization request
Resolving members calls in regards to eligibility problems, COBRA, claims & other concerns about coverage
Taking calls from pharmacies with eligibility problems
Providing drug authorization and confirmation of drug co-pays amounts
Researching of any RX claims issues
Responding to incoming correspondence as it relates to claims and file as needed
Maintain member satisfaction and retention via rapport building and proper identification of member, employer, provider, and service representative needs
Special Talents:
Incredible Listening skills, while maintaining phone talk time
Excellent verbal and written communication skills
Ability to organize and prioritize customer needs
2+ Years of prior call center experience
6 months+ Healthcare experience preferred
HS Diploma required, AA or BA preferred
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