Job Description

CUSTOMER SUPPORT REPRESENTATIVES NEEDED FOR A CONTRACT OPPORTUNITY WITH OUR CLIENT IN ORANGE, CA.

POSITION IS CURRENTLY WORKING REMOTELY, HOWEVER WILL RETURN TO THE OFFICE.

JOB DESCRIPTION

The Member Services Representative serves as the liaison between members, providers, and internal departments to ensure that every member is receiving the customer service experience that they deserve. You will navigate our client's members through their health plan and supplemental benefits, care delivery model, and provider network. You will follow members throughout their journey ensuring member satisfaction and customer service are provided at a level of excellence.

• Be knowledgeable in procedures, protocols, benefits, services, and any other necessary information to resolve member issues and inquiries; serve as a "subject matter expert” in the health care experience that our client's members navigate daily.
• Meet call metrics, ensure member satisfaction, verify the member is included in or targeted for any outreach or care gap programs and connect members to programs or services when appropriate. Analyze available programs, determine program eligibility, and connect member to appropriate provider or vendor.
• Resolve incoming calls concerning members' eligibility, benefits, provider information, clinical, and pharmacy needs; coordinate membership changes such as member's primary care physician and proactively engage member with their wellness plan options.
• Collaborate with our client's partners – including but not limited to other departments, supplemental benefit vendors, and provider network – to facilitate the member experience.
• Responsible for receiving inbound phone calls within the department's goal time frame, and for performing outbound courtesy calls as needed; may be required to communicate with members in other channels including e-mail, web chat, SMS/text, as required.
• Manage to the member's communication preferences as possible, which may include time of day, channel, and language; utilize interpreter service as needed.
• Responsible for real-time documentation (i.e., caller name, contact info, call reason, action taken, resolution, etc.) and timely wrap-up to support outcomes reporting, in all systems/applications as required.
• Must enter member demographics and information with accuracy and attention to detail; feel responsible for the quality of our client's data.
• Excel in customer service and contribute to a culture of going "above and beyond” to ensure the highest level of member satisfaction.
• Adhere to all applicable attendance policies to ensure consistent and reliable queue coverage, which is essential to the member experience.

QUALIFICATIONS

• High school diploma or general education degree (GED); or one year minimum of related experience and/or training; or equivalent combination of education and experience.
• Bilingual abilities in either: Spanish, Vietnamese, Chinese (Mandarin or Cantonese), or Korean.
• High-volume inbound customer service experience, particularly for health plan or Medicare "Member Services” roles in health plan and supplemental benefits.
• Telemarketing and/or member outreach experience.
• Specialized experience in escalation or resolution units.
• Health care delivery experience including appointment scheduling for preventive health, outpatient clinic setting, and/or home visit setting; or care coordination / case management telephonic roles.
• Any specialization in Medicare Advantage, managed care, or HMO.
• Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.
• Ability to write routine reports and correspondence.
• Ability to speak effectively before groups of customers or employees of the organization.
• Ability to add and subtract two-digit numbers and to multiply and divide with 10's and 100's. Ability to perform these operations using units of American money and weight measurement, volume, and distance.
• Ability to apply common sense understanding to carry out detailed, but un-involved written or oral instructions.
• Ability to deal with problems involving a few concrete variables in standardized situations.
• Strong computer skills including typing 40+ words per minute.
• Excellent communication skills, oral, and written.

Company Description

Platinum Resource Group is a professional level consulting firm, providing resources to Fortune 1000 client companies in the areas of technology, human resources, accounting, finance, business systems and supply chain, on a contract and interim basis. PRG has operations in Orange County, San Diego, Los Angeles and San Francisco. As a W-2 employer we offer our consultants direct deposit bi-weekly payroll, health, dental, vision benefits, paid holidays, and referral bonuses.