Job Description

Community Health Group is a locally based non-profit health plan that ensures access to high quality, culturally sensitive health care for underserved communities throughout San Diego County. We treat our 300,000+ -member, multi-lingual staff like family, encouraging an atmosphere of collaborative teamwork, continuous learning, personal growth, and promotion from within. Recognized as one of the Top Workplaces in San Diego, CHG offers its employees such benefits as tuition reimbursement, a meditation room and yoga classes, a monthly Breakfast With The CEO, and memorable events throughout the year.

We know that by serving our employees well, they, in turn, will better serve our nearly 300,000+ membership. We have been recognized consistently for the excellence and sensitivity of our customer service by members, physicians, vendors, and a full range of health care providers. We are accredited by the National Committee for Quality Assurance and proud of our continuing company-wide Quality Initiatives.

We are currently recruiting for:

TITLE:  Member Services Representative- Bilingual Spanish 

Target Hiring Range: $ 17.85- $ 20.53 Per Hour

EEO1: Administrative Support Worker

POSITION SUMMARY

Drives customer loyalty and provides excellent telephonic customer service to our customers (members and providers). This position will work with other departments in order to respond to customer and provider concerns in a timely and effective manner.

COMPLIANCE WITH REGULATIONS:

Works closely with all departments necessary to ensure that the processes, programs and services are accomplished in a timely and efficient manner in accordance with CHG policies and procedures and in compliance with applicable state and federal regulations including CMS and/or Medicare Part D, DHCS and DMHC.

RESPONSIBILITIES

• Resolves member concerns in a timely manner by recommending and facilitating options including:
  • Coordinates urgent care accessibility by providing locations or scheduling appointment at urgent care of members choice
  • Coordinates interpreter services for non-English speaking members by scheduling in person interpreter or connecting to over the phone interpreter
  • Arranges member transportation: assist with MTS applications, send taxi voucher, or mail bus/trolley passes.
  • Makes Primary Care Provider changes based on member needs or preference.
  • Refers and transferring to Telephone Advice Nurse for health related questions.
  • De-escalates difficult members by providing excellent customer service and giving options.
• Coordinates and facilitates emergency transfers of site and providing enrollment verification to providers involved.
• Documents all member and provider communications by entering the following:
  • Issue statements- identifying the main reason for the call
  • Steps to resolve- showcasing the representatives work towards resolution
  • Issue Resolutions- summarizing the reason and outcome of the call

• Assists in primary care site discharges by reviewing provider requests and providing available options to member while ensuring a smooth transition.
  • Educates provider of 30 day responsibility after date of discharge, member may return to office for emergency visits or prescription fills.
• Completes “Welcome Calls” within the first two weeks of every month (will require about 10 hours of overtime per month).
  • Informs member of plan benefits and ID card
  • Informs member of home visits after a hospital visit
• Works effectively with all departments in the organization to accomplish member care and provider/vendor assistance.
• Works closely with community based ethnic service and advocacy programs by identifying the members or families non-medical and social needs and referring these to the appropriate organizations for assistance.
  • Connect member to 211 services
  • Uses specialized internet sites to find community resources that fit the members’ needs
• Maintains product and company reputation by conveying professional image, and contributes to the team effort by accomplishing related tasks:
  • Participating in committees and in meetings
  • Professionally represents the company at community functions
  • Performing other duties as assigned or requested.
  • Embodies the company’s customer service philosophy of MAGIC
• Follow established procedures to meet member, provider, and vendor needs.
• Identifies operational issues preventing the delivery of exceptional customer service by documenting and referring these to Member Services Supervisors for follow-up and resolution.
• Assist department in reaching call handling goals, first call resolution goals, complaint resolution, member retention and closing all cases initiated by representative.
• Accountable for consistently demonstrating the knowledge, skills, abilities and behaviors necessary to provide superior and culturally sensitive service to the team, members, providers, and any external vendors.
• Identifies and initiates continuity of care for qualifying members.
• Maintains the telephone abandonment rate within 1% by working as a team in answering incoming Member Services telephone lines.
• Perform other duties as required
• Work on special projects as required- short or long term projects.

How to Apply

• AA Degree or Equivalent (Required)

• One year of experience in a call center (preferred)
• Strong customer service background.
• Bilingual English/Spanish
• Excellent communication and interpersonal skills.
• Ability to exercise mature and independent judgment.
• Typing skills

• Prolonged periods of sitting.
• Extensive use of telephone.
• Will be required to work evenings and/or weekends.

Job Categories: LGBT. Job Types: Full-Time. Salaries: 40,000 - 60,000.

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