Western Health Advantage · 4 hours ago
Member Service Representative III
Sacramento, CA
Full-time
Hybrid
Mid, Senior Level
$25/hr - $27/hr
3+ years expWestern Health Advantage is seeking an experienced Member Service Representative III to serve as a primary point of contact for members, providers, brokers, and plan partners. In this senior-level call center role, you will handle complex inquiries related to health plan benefits and support other Member Service Representatives.
Health CareInsurance
Responsibilities
Responding to member inquiries related to Commercial, Exchange, and Individual plans via phone, email, chat, and fax
Providing in-person support to walk-in members as needed
Resolving complex or high-level issues that require research, investigation, or coordination with internal departments or external partners
Supporting other Member Service Representatives by answering questions and providing guidance on plan rules, benefits, policies, and system navigation
Assisting with urgent or sensitive cases, including those involving access to care or referral to the Member Relations Unit
Providing training support and call shadowing for new Member Service Representatives
Assisting members, providers, brokers, and plan partners with claims-related billing questions as needed
Collaborating with inter- and intra-department teams to ensure timely resolution of member issues within established timeframes
Educating members on the Advantage Referral Program, the WHA website, and available online self-service tools
Accurately documenting and referring appeals and grievances in accordance with departmental protocols
Managing difficult or emotional customer situations with professionalism, empathy, and discretion
Meeting departmental standards related to quality, productivity, and attendance
Reporting system issues or emerging call drivers to the Member Service Supervisor or Manager
Participating in meetings related to system upgrades or changes and sharing relevant information with the team
Performing special projects and additional duties as assigned
Qualification
Required
High School Diploma or equivalent
Minimum of 3 years of experience working in a call center with increasing levels of responsibility
Intermediate computer skills, including email, databases, word processing, spreadsheets, and graphics
Strong written and verbal communication skills
Ability to read, write, speak, and understand the primary language(s) used in the workplace
Preferred
Previous experience working in the healthcare industry, particularly within an HMO environment
Company
Western Health Advantage
Western Health Advantage is is all about helping people obtain quality health care & also support medical innovation
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Garry Maisel
President and Chief Executive Officer
Recent News
Sacramento Business Journal
2025-03-19
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2025-03-17
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2025-03-11
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