Alameda Alliance for Health
Member Services Representative I
Alameda Alliance for Health, Alameda, California, United States, 94501
Overview
Hybrid: Full Time must live in one of 6 states: CA, AZ, NV, TX, WA, OR; remote and on site in Alameda County. Available for Full-Time Work Schedule 8:00am - 5:00pm Pacific Time, Monday-Friday. Hybrid positions work a minimum of up to 2 days per week in Alameda Alliance for Healths office, located at Alameda CA, and a minimum of three days per week remotely. Base pay
$22.88/hr - $34.33/hr Responsibilities
Member Services Representatives (MSR) are the first point of contact for members primary contact with the Alliance for both routine and complex member issues with the goal of delivering excellent customer service. Answer a high volume of inbound and outbound calls in a timely manner; respond to all communications coming into Member Services in the form of email, fax, letters, chat and phone calls; document all conversations in the electronic database. Identify caller needs, clarify information, research issues, and provide solutions and/or alternatives whenever possible. Act as liaison between the plan, the provider network, and other community agencies; work in a call center and assist other departments with responses to member issues as needed. Essential functions
Receive, manage, and document calls, emails, and other contacts from members and providers; explain health plan benefits and plan rules; describe services offered. Resolve member problems by coordinating with other departmental staff; create and mail member communications as needed. Maintain data integrity in the CRM system; comply with DMHC regulatory requirements and DHCS contractual obligations. Manage escalated calls and back-up coverage as required; participate in department projects. Physical requirements
Constant sitting at a desk and keyboard use; frequent data entry with multi-monitor setup; frequent telephone use. Frequent walking and standing; ability to lift 0-30 lbs as needed. Minimum qualifications
Bachelors degree or equivalent experience preferred; high school diploma or GED required. Minimum one year of direct customer service experience; call center and managed care experience a plus. Experience determining eligibility for financial assistance, insurance benefits, unemployment, and/or other social services programs. Demonstrated knowledge of Alameda Alliance Member Services policies and procedures; track record of meeting performance metrics; proficiency with CRM and related tools. Ability to work with minimal supervision; strong teamwork and communication skills. Special qualifications (skills, abilities, licenses)
Ability to prioritize and adapt to changing situations; remain calm and professional in stressful situations. Excellent problem-solving and interpersonal skills; strong verbal and written communication; able to explain complex terminology in simple terms. Proficient in data entry; 40 net words per minute typing; proficient with Microsoft Windows and Office applications; experience with CRM tools and PBM systems desirable. Reliable internet connection for remote work (50-100 Mbps). Salary range
$22.88 - $34.33 per hour. The Alliance is an equal opportunity employer and makes all employment decisions on the basis of merit and business necessity. We strive to hire the best-qualified person for every job. We prohibit unlawful discrimination based on race, color, religious creed, sex, gender, transgender status, age, sexual orientation, national origin, ethnicity, citizenship, ancestry, religion, marital status, familial status, status as a victim of domestic violence, assault or stalking, military service/veteran status, physical or mental disability, genetic information, medical condition, and other statuses protected by law. #J-18808-Ljbffr
Hybrid: Full Time must live in one of 6 states: CA, AZ, NV, TX, WA, OR; remote and on site in Alameda County. Available for Full-Time Work Schedule 8:00am - 5:00pm Pacific Time, Monday-Friday. Hybrid positions work a minimum of up to 2 days per week in Alameda Alliance for Healths office, located at Alameda CA, and a minimum of three days per week remotely. Base pay
$22.88/hr - $34.33/hr Responsibilities
Member Services Representatives (MSR) are the first point of contact for members primary contact with the Alliance for both routine and complex member issues with the goal of delivering excellent customer service. Answer a high volume of inbound and outbound calls in a timely manner; respond to all communications coming into Member Services in the form of email, fax, letters, chat and phone calls; document all conversations in the electronic database. Identify caller needs, clarify information, research issues, and provide solutions and/or alternatives whenever possible. Act as liaison between the plan, the provider network, and other community agencies; work in a call center and assist other departments with responses to member issues as needed. Essential functions
Receive, manage, and document calls, emails, and other contacts from members and providers; explain health plan benefits and plan rules; describe services offered. Resolve member problems by coordinating with other departmental staff; create and mail member communications as needed. Maintain data integrity in the CRM system; comply with DMHC regulatory requirements and DHCS contractual obligations. Manage escalated calls and back-up coverage as required; participate in department projects. Physical requirements
Constant sitting at a desk and keyboard use; frequent data entry with multi-monitor setup; frequent telephone use. Frequent walking and standing; ability to lift 0-30 lbs as needed. Minimum qualifications
Bachelors degree or equivalent experience preferred; high school diploma or GED required. Minimum one year of direct customer service experience; call center and managed care experience a plus. Experience determining eligibility for financial assistance, insurance benefits, unemployment, and/or other social services programs. Demonstrated knowledge of Alameda Alliance Member Services policies and procedures; track record of meeting performance metrics; proficiency with CRM and related tools. Ability to work with minimal supervision; strong teamwork and communication skills. Special qualifications (skills, abilities, licenses)
Ability to prioritize and adapt to changing situations; remain calm and professional in stressful situations. Excellent problem-solving and interpersonal skills; strong verbal and written communication; able to explain complex terminology in simple terms. Proficient in data entry; 40 net words per minute typing; proficient with Microsoft Windows and Office applications; experience with CRM tools and PBM systems desirable. Reliable internet connection for remote work (50-100 Mbps). Salary range
$22.88 - $34.33 per hour. The Alliance is an equal opportunity employer and makes all employment decisions on the basis of merit and business necessity. We strive to hire the best-qualified person for every job. We prohibit unlawful discrimination based on race, color, religious creed, sex, gender, transgender status, age, sexual orientation, national origin, ethnicity, citizenship, ancestry, religion, marital status, familial status, status as a victim of domestic violence, assault or stalking, military service/veteran status, physical or mental disability, genetic information, medical condition, and other statuses protected by law. #J-18808-Ljbffr