Senior Member Services Representative

Location: Merced County, California; Monterey County, California; San Benito County, California

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

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 during the interview process.

The full compensation range for this position is listed by location below.

The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).