MEMBER SERVICE REPRESENTATIVE in San Diego, CA at Scripps Health Plan Services -4S Ranch

Date Posted: 8/4/2018

Job Snapshot

Job Description

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 position will cover both Scripps Health Plan and Scripps Health Plan Services MSO Customer Service lines.  These lines receive calls from members, providers, vendors and health insurance companies related to a variety of questions, issues and other needs.

Job Requirements

Required Education/Experience/Specialized Skills: 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.

Required Certification/Registration:

Preferred Education/Experience/Specialized Skills/Certification:Previous Health Plan experience in a California HMO environment. CRM or Salesforce experience.

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.