MEMBER SERVICES REPRESENTATIVE
Company: Network Medical Management Inc
Location: El Monte
Posted on: January 12, 2022
SUMMARYUnder general supervision, following established
procedures, assist and direct patients in an empathetic and caring
manner, efficiently and timely, and completes appropriate
documentation. Responds to provider inquiries and attempts to
resolve provider concerns or refers to management for
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Answer all daily telephone calls from members, providers,
health plans, insurance brokers, collection agents and
- Elicit information from members/providers including the problem
- Research and resolve authorizations, claims, eligibility,
concerns and resolve. If unable to resolve, refer to management for
- All calls carefully documented into Company's customer service
- Member/Provider Service/Representative assists Supervisor and
Manager with other duties as assigned.
- Member outreach communications via mail or telephone.
- Resolve walk-in member concerns.
- Assistance to other departments when back up is required;
marketing event participation.
- Able to provide quality service to the customers.
- Able to communicate effectively with customers in a
professional and respectful manner.
- Maintain strictest confidentiality at all times.
- Specialist termination notifications sent to members.
- Initial Health Assessments sent to members, as needed.
- SCAN members welcome calls.
- All other duties as assigned.QUALIFICATIONSTo perform this job
successfully, an individual must be able to perform each essential
duty satisfactorily. The requirements listed below are
representative of the knowledge, skill, and/or ability required.
Reasonable accommodations may be made to enable individuals with
disabilities to perform the essential functions.
EDUCATION and/or EXPERIENCEHigh school diploma or general education
degree (GED); and one year related experience and/or training; or
equivalent combination of education and experience.
LANGUAGE SKILLSAbility 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 organization. Bilingual Mandarin/Cantonese or
Keywords: Network Medical Management Inc, El Monte , MEMBER SERVICES REPRESENTATIVE, Sales , El Monte, California
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