Job Details

Job Title: Member Services Representative

Location: Fountain Valley CA

Duration: 2+ Months contract with possible extension

Top 3 Keywords:

1- Managed Healthcare/Health Plan Customer Service

2. Member Grievances & Appeals Processing

3. Specialty Coding Certification

Must-Have Skills:

• Minimum 2 years of experience in a transaction-based or call center environment
• Strong verbal and written communication skills
• Ability to build rapport and demonstrate empathy with members
• Basic computer skills (MS Word, Excel)
• Typing speed of 45 WPM
• Ability to multitask and meet productivity and quality standards
• Attention to detail and strong organizational skills
• Ability to maintain confidentiality (HIPAA compliance)

Key Responsibilities and Duties:

• Serve as the primary point of contact for members via phone, email, internet, and written correspondence
• Document and track member, provider, and sponsor interactions accurately
• Educate members on benefits, policies, rights, and responsibilities
• Process member grievances, appeals, and service requests Support multiple service queues (Claims, Medical Management, Provider Services)
• Review member claims history to ensure accurate benefit tracking

Requirements:

• High School Diploma or GED (required)
• 2+ years of call center or transaction-based experience
• Typing speed of at least 45 words per minute
• Basic proficiency with Microsoft Word and Excel
• Specialty coding certification (required)