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Kern Family Health Care · 19 hours ago

Member Services Representative-Temporary

Bakersfield, CA

Full-time

Onsite

Entry, Mid Level

$22/hr - $22/hr

2+ years exp

Kern Family Health Care is dedicated to improving the health status of its members through an integrated managed health care delivery system. They are seeking a Member Services Representative to provide excellent customer service and act as an advocate for members, resolving healthcare service concerns and ensuring member satisfaction.

Health CareHospitalNon Profit

Growth Opportunities

Responsibilities

Strive to practice KHS’ Mission, Vision and Values (MVV) every day, and strongly commit to advance the organization’s strategic plan

Provide the best customer service and member advocacy that reflects KHS’ MVV

Work directly with members and service providers to identify and resolve health care service concerns

Acts as the member advocate promoting timely complaint and problem resolution, while representing Kern Health Systems with every interaction

Responsible for timely, detailed and accurate responses to member inquiries. Assists with the processing of complaints and grievances in accordance with the health plan’s grievance policies and procedures and regulatory agency requirements

Responds to time critical questions with detailed and expeditious follow-up to promote accurate and timely processing of issues

Employs effective communication methods to promote positive and productive public relations with members, providers and other departments

Identifies, investigates, resolves, and reports member/provider issues to management

Promotes high standards of member satisfaction and access to medical care by documenting feedback from members. Any deviations from established standards are documented in QNXT and reported to management for evaluation

Prepares reports and submits results through the established administrative channels

Maintains an effective, efficient and confidential filing and tracking system to facilitate easy retrieval of contact information while maintaining confidentiality in accordance with established policies and regulations

Documents all interactions with members and providers by appropriately coding and logging information in QNXT

Answers phones in a specified time frame, while maintaining a high quality of service for the members and providers

Responsible for Member Retention efforts which may include but are not limited to telephone surveys conducted to monitor member satisfaction

Assembles and provides current Plan information requested by members ensuring that the information is accurate

Responsible for assisting the Member Services Trainer with training new Member Services Representatives as they are hired

Assist members, providers or other KHS Departments with scheduling medical appointments and assisting with scheduling transportation needs for members

Assists management staff in completing member services related special projects

Organizes and maintains departmental files, records, handbooks and manuals

Utilizes personal computer for detailed data analysis, report generation, documentation and project evaluation purposes

Performs other job-related duties as required

Adheres to all company policies and procedures relative to employment and job responsibilities

Qualification

Customer serviceProblem solvingCommunication skillsTyping skillsData analysisConflict resolution

Required

High School Diploma from an accredited school or equivalent

Two (2) or more years of recent experience in a customer service organization or related field with a high degree of problem solving and decision making

Strong telephone and communication skills required

Typing skills of 30+ NWPM

Company

Kern Family Health Care

Kern Health Systems, known as Kern Family Health Care, was established in 1993 as a managed care health plan, and is the largest health plan in Kern County.

Founded in 1993

Bakersfield, California, USA

501-1000 employees