Member Service Representative in San Diego, CA at Scripps Health Plan Services -4S Ranch

Date Posted: 7/9/2019

Job Snapshot

Job Description

At Scripps Health, you will experience the pride, support, and respect that has been repeatedly recognized as one of the nation’s Top 100 Places to Work.



You’ll be surrounded by people committed to making a difference in the lives of their patients and their teammates. So if you’re open to change, go ahead and unlock your potential.



Join4S Ranch is located in sunny San Diego, CA and minutes from our beautiful beaches. You will experience the pride, and support of being a member of an outstanding team at our Scripps Health Plan Services where you will be a part of a department making an average of 400 calls daily. We share a culture of providing excellent care to our patients and each other.



The Member Service Rep under general direction, provides customer service to all health plan populations such as Members, Brokers, Employer Groups, external agencies, and Potential Members by answering complex benefit questions, resolving issues, and educating callers in an accurate, respectful and timely manner. Provides callers with plan specific information such as medical benefits and eligibility, coverage descriptions, copays, utilization management guidelines, claim processing and review, network participation, appeals and grievances, Primary Care Provider and Medical Group selection and assignment, preventative services, pharmacy benefits, and plan specific exclusions. Understands health plan products and operations such as premiums and enrollment criteria as required by state and federal regulations.



This is a Full Time position located at our 4S ranch business services office.



Job Requirements

Required Qualifications:

  • Customer-focused behavior in a call center setting; helping approach, including listening skills, patience, respect, and empathy.
  • Ability to speak with great specificity and knowledgeable detail about areas of responsibility.
  • Ability to repeatedly produce high quality results.
  • Ability to function in a fast-paced environment while maintaining focus and control of workflows.
  • Constantly meets & exceeds Customer Service benchmarks through Quality Monitoring Evaluations & Member Surveys.
  • Critical thinkers with ability to provide and coordinate accurate follow-up and attention to detail to each call contact.
  • 3 or more years of customer service experience.
  • Knowledge of medical terminology and managed care policies.
  • Incoming Call Center and/or Incoming Contact Center experience in Customer Service.
  • Ability to function in a multi-system Microsoft environment using Word/Excel/Outlook the Internet, and department software applications such as IDX/Epic or other CRM software.

Preferred Qualifications:

  • Previous Health Plan experience in a California HMO environment.
  • CRM or Sales force experience.


Scripps Health is repeatedly named on the Fortune Magazine’s 100 Best Companies to work for, only San Diego-based company and Becker’s Healthcare Top Hospitals. Scripps Health offers a robust Total Rewards Program designed to compensate and motivate you throughout your career. Scripps Health Total Rewards Program includes a broad range of plans and programs including market competitive pay and performance incentives, health and wellness benefits, financial wellness benefits, work-life resources, learning and development opportunities, and rewards and recognition. Unlock your potential with Scripps Health today.

Scripps Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex (including pregnancy, sexual orientation, or gender identity/expression), age, marital status, status as a protected veteran, among other things, or status as a qualified individual with disability.