Job Title: Member Services Representative II

Department: Member Services

Pay Rate: $18-22/hr

Job Type: Full-time

Process: In-person interviews

Location: Sacramento

Job Description:

LHH Staffing is seeking a Member Services Representative II for a well-established local healthcare plan. This role prioritizes customer service, with the organization ranked in the top three in the industry. The company is community-focused, emphasizing member experience and employee growth, and is expanding its offerings.

As the initial point of contact for members, providers, and others, the Member Services Representative sets the tone and creates the customer experience. Responsibilities include answering calls and resolving issues, potentially involving interaction with other departments or external entities. This challenging position requires critical thinking, empathy, emotional intelligence, excellent writing, and superior customer service skills.

Duties include, but are not limited to:

• Resolving incoming calls concerning members' eligibility, benefits, provider information, monthly premium billing, medical claims billing, status, and clinical and pharmacy needs.
• Coordinating member plan needs from changing a Primary Care Provider to assisting with clinical or pharmacy-related matters.
• Accurately documenting and directing appeals and grievances according to department protocols and procedures and assisting with research and resolution.
• Researching and validating claims and/or billing issues, and following department procedures and policies to resolve these issues within set timelines.
• Reviewing and analyzing member claims for accuracy as well as educating members on how benefits are applied.

Requirements and Qualifications:

• High school diploma.
• Minimum of 2 years of customer service experience in a contact/call center environment, healthcare experience preferred.
• Knowledge of medical terminology and services is helpful.
• Bilingual (Spanish) is a plus.
• Good tenure and solid call center experience required.
• Healthcare background (HC BG) is a must.

• The California Fair Chance Act
• Los Angeles City Fair Chance Ordinance
• Los Angeles County Fair Chance Ordinance for Employers
• San Francisco Fair Chance Ordinance