Senior Member Services Representative

 

We have an opportunity to join the Alliance as a Senior Member Services Representative in the Member Services Call Center Department. 

WHAT YOU'LL BE RESPONSIBLE FOR

Reporting to the Member Services Supervisor, this position:

• Responds to complex member issues and acts as a technical resource for Member Services Representatives
• Acts as a frontline customer service representative within the Member Services Department, providing assistance to members and providers primarily by phone
• Participating in departmental work groups and special projects

 

ABOUT THE TEAM

​Our teams work together to empower members to understand Alliance services and provide resources that meet medical, cultural and social needs to improve member health and well-being. We answer calls from Alliance members, which may include general questions about the plan, require help finding a primary care provider or bring up an issue that needs resolution.

 

THE IDEAL CANDIDATE 

• Has a passion for providing high-quality customer service to diverse communities while also contributing to a positive and supportive work environment.
• Has strong interpersonal skills to resolve member issues and provide resources as needed.
• Is familiar with Medicare, Medi-Cal, managed health care, and social services.
• Has experience working in a call center or member services setting.
• Is adaptable and comfortable working in the office or remotely multiple days a week.
• Has the ability to work in a team-orientated environment and interact with others showing respect and understanding.

 

WHAT YOU'LL NEED TO BE SUCCESSFUL

To read the full position description, and list of requirements click here.

• Knowledge of:
  • Bilingual (English/Spanish or English/Hmong) is required for positions in all Alliance service area counties, except Mariposa County, and except when assigned to the D-SNP call queue
  • Thorough knowledge of the principles and practices of customer service
  • Working knowledge of the principles and practices of managed health care in a health plan environment
  • Working knowledge of eligibility processes and guidelines associated with one or more of the following: the Medi-Cal program, Medicare Advantage or D-SNP programs, Social Security programs, foster care, adoption assistance, and/or other public assistance programs
  • Working knowledge of general administration procedures, standard business office practices and the operation of general office equipment, such as computer, fax, and copier

• Ability to:
  • Ability to answer telephone calls promptly and minimize delays that may lead to missed calls
  • Ability to act as a technical resource for Member Services Representatives
  • Ability to de-escalate complex situations, including complaints
  • Ability to understand and communicate the complex operations and processes of the Alliance, particularly those related to Member Services and Care Management, to members and providers
  • Ability to translate healthcare-related terminology and complex processes into simple language and step-by-step instructions when communicating with members and providers

• Education and Experience:
  • High school diploma or equivalent and a minimum of four years of customer service experience in member services, health care, public assistance, human services or in a customer service or call center environment which included a minimum of two years of experience in a health care setting which included assisting members and/or providers with eligibility processes and guidelines
  • An Associate’s degree may substitute for one year of the general customer service experience; one year of experience as a Member Services Representative in a Medi-Cal or Medicare call center may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying

 

OTHER INFORMATION

• We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams.
• While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
• In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed dur