Member Services Representative I/II, South San Francisco, CA
MEMBER SERVICES REPRESENTATIVE I/II
(CHINESE SPEAKING REQUIRED)
The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time Member Services Representative to perform the following essential duties & responsibilities:
- 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.
- Conduct welcome calls.
- Document all activities in PhoneLog.
- Assist members in resolution of problems, complaints, and grievances in an accurate and timely manner.
- Refer unresolved complaints to the Grievance and Appeals Unit via Everest as appropriate.
- Assist members in selecting and changing their PCP.
- 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.
- Professionally represent Plan and Department in internal and external meetings, including community outreach events.
- Participate in health fairs, community partnerships, meetings, committees, and coalitions as requested by the Member Services Supervisor.
- Work with entire Member Services department to continuously measure and improve the performance of the department and HPSM; participate in department meetings, submit reports.
Education and Experience:
- Equivalent to a high school diploma or GED required
- At least (1-2) year experience in a customer service environment highly desirable.
Knowledge of: Health insurance programs; Managed care, Medi-Cal, and/or Medicare is preferred.
Ability to: Communicate effectively, both verbally and in writing. Present information to others in a group or one-on-one setting. Research issues and resolve problems. Be diplomatic when working with members regarding difficult/sensitive issues. Provide excellent customer service. Use a computer-based database system. Successfully problem solves through the use of good judgment; and speaks, read, and understand Spanish at a fluent level.
Other Requirement: Fluency in Chinese is required for this position.
Starting Compensation Range: $20.11/hour- $25. 04/hour – depending on experience
Benefits Information: Excellent benefits package offered, including HPSM paid premiums for employee’s coverage in the medical HMO plan and majority of PPO medical cost. Employee pays a small portion (5%) of the dependent premiums for medical and dental benefits. Additional HPSM benefits include fully paid vision, life, AD&D, STD, and LTD insurance; retirement plan (10% of salary for compensation/HPSM paid); holiday and vacation pay; tuition reimbursement plan; and more.
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: firstname.lastname@example.org or via fax: (650) 616-8039. File by: Continuous until filled. EOE