Member Relations Representative

Job Description

The Member Relations Representative is responsible for acting as a liaison between members, health plans, and physicians. Individuals are required to perform at minimum 120 outbound attempts per day to Medi-Medi, Medicare, Commercial, POS and Medi-Cal members who are existing members with enrollment errors or are identified as potential terminations and other services necessary to ensure member healthcare satisfaction, wellness, and retention is accomplished.

Responsibilities

• Complete all outbound retention effort campaigns as assigned
• Complete all inbound retention calls.
• Track outcome of all retention efforts
• Assist with member inbound calls as needed.
• 100% thorough documentation of every call.
• Thoroughly verify HIPAA requirements to ensure account accuracy.
• Follow-up on all open issues.
• Communicate recurring issues and trends to management.
• All other duties as assigned.
  
  

Qualifications

Minimum Education: Bachelor’s Degree preferred. High School Diploma or equivalent required.

Minimum Experience: A minimum of two years of customer service experience in a call center environment required. A minimum of two (2) to three (3) years of IPA/HMO experience. Ability to project excellent customer service, negotiation, and conflict resolution skills via telephone in a fast-pace environment while maintaining a professional demeanor. Bi-lingual preferred. Advanced working knowledge in Microsoft Programs (PowerPoint, Word and Excel). Ability to multi-task, prioritize, and work in a fast pace environment. Knowledge of IPA/HMO. Proficiency in Microsoft Office Excel and Outlook applications.

Req. Certification/Licensure: None.

"Location-Based Pay Adjustment"

About Us

With approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas and Rhode Island. Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services. Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare. For 25+ years, Prospect Medical has been focused on our mission of supporting independent physicians where, through risk arrangements, we work closely together with health plans, facilities and healthcare physicians for the benefit of every person who comes to us for care. We provide quality healthcare services that are designed to offer our patients highly coordinated, personalized care and that help them live healthier lives. Prospect Medical Systems manages highly successful IPAs by leveraging our best-practices, results-driven administrative services to manage patients under risk arrangements with health plans/CMS.