Top 4718 Claim Service Adjust Jobs

Member Service Representative
Champion Health Plan/ Champion Payer Solutions —Long Beach, CA
- From $22 an hour
- Weekends as needed
- Spanish
- Microsoft Excel
- Microsoft Outlook
- Health insurance
- Dental insurance
Quick Apply
Claims Adjuster Trainee
National General —Colorado
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Telephone Claims Adjuster
National General —Ontario, CA
- $21.20 - $50.24 an hour
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Contract Claims Services, Inc. —Remote
- Full-time
- Remote
- High school diploma or GED
- Bachelor's degree
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Remote Customer Service/Sales Representative
Agent Alliance —Forest Hills, NY
- $65,000 - $70,000 a year
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Client Coordinator
EPIC Brokers —Remote
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- Microsoft Outlook
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Nurse Practitioner - Prescott
MEDEVAL —Prescott, AZ
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Audiologist - Omaha, NE
Clay Consulting —Omaha, NE
- $90,000 - $120,000 a year
- Part-time
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Sales Account Manager
NORTHERN ENGRAVING CORPORATION —Sparta, WI
- Overtime
- Marketing
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Licensed Optician FT Troy, OH #320
Eyemart Express —Troy, OH
- $22.50 - $26.00 an hour
- Full-time
- Communication skills
- Entry level
- Disability insurance
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Remote Mental Health Provider (LPC, LCSW, LMFT, LMHC)
Telemynd —New Hampshire
- $100,000 - $150,000 a year
- Choose your own hours
- Remote
- LMFT
- Licensed Clinical Social Worker
- Mid-level
- Dental insurance
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12d
BCBA Clinical Director - Alliance, Fort Worth
Thrive Behavior Centers —Fort Worth, TX
- $91,000 - $105,000 a year
- Full-time
- CPR Certification
- BLS Certification
- Master's degree
- Continuing education credits
- Paid parental leave
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Licensed Optician
Eye Centers of America, LLC —Dover, NJ
- $35 - $40 an hour
- Full-time
- Clinic experience
- Mid-level
- High school diploma or GED
- Health savings account
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Licensed Optician FT Summerville SC #285
Eyemart Express —Summerville, SC
- Full-time
- Communication skills
- Entry level
- Disability insurance
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Jewelry Service Consultant
Day's Jewelers —Waterville, ME
- Weekends as needed
- OSHA
- High school diploma or GED
- Ability to lift 50 pounds
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Remote Mental Health Provider (LPC, LCSW, LMFT, LMHC)
Telemynd —Maryland
- $100,000 - $150,000 a year
- Choose your own hours
- Remote
- LMFT
- Licensed Clinical Social Worker
- Mid-level
- Dental insurance
- Vision insurance
Quick Apply
12d
Property Claim Specialist
Colorado School Districts Self Insurance Pool —Centennial, CO
- $99,886 - $129,101 a year
- Full-time
- Microsoft Word
- Background check
- Clean driving record
- Health savings account
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Senior Risk Management & Insurance Analyst
Rotary International —Evanston, IL
- $99,900 - $111,000 a year
- Customer service
- 5 years
- Data analysis skills
- Health insurance
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Remote Mental Health Provider (LMFT)
Telemynd —Los Angeles, CA
- From $70 an hour
- Choose your own hours
- Remote
- LMFT
- Licensed Clinical Social Worker
- LPC
- Flexible schedule
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Remote Mental Health Provider (LMFT)
Telemynd —San Jose, CA
- From $70 an hour
- Choose your own hours
- Remote
- LMFT
- Licensed Clinical Social Worker
- LPC
- Flexible schedule
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12d

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Member Service Representative

Champion Health Plan/ Champion Payer Solutions
Long Beach, CA

Quick Apply

Job Details

Full-time
From $22 an hour

Benefits

Health insurance
Dental insurance
401(k)
Paid time off
Vision insurance
Flexible schedule

Qualifications

Spanish
Customer communication
Teamwork
Customer retention
Managed care
Managed care organization experience
Call center experience
HIPAA
English
Vietnamese
High school diploma or GED
Medical terminology

Full Job Description

SCOPE OF ROLE

The Member Service Representative (MSR) serves as the first point of contact for customers, providers, and advocates, ensuring exceptional customer experiences through accurate and helpful communication. This role involves handling incoming calls from Medicare Advantage members, assisting with benefit inquiries, referrals, claims, and guiding them to community resources as needed. The ideal candidate will be bilingual, proficient in medical terminology, and knowledgeable in CMS, Medicare, and HIPAA regulations. Strong proficiency in Microsoft Applications and a commitment to delivering top-tier service are essential.

ROLE RESPONSIBILITIES

The Member Service Representative job description is intended to point out major responsibilities within the role, but it is not limited to these functions:

KEY RESPONSIBILITIES % OF TIME

 Serve as the primary point of contact for customers, providers, and advocates, handling calls with professionalism and courtesy.

 Provide clear, concise, and accurate information to ensure customers fully understand their benefits, referrals, claims, and available resources.

 Ensure prompt and efficient service by answering all incoming calls within the

department’s established time frame.

 Escalate complex issues to management or relevant departments as necessary to

ensure customer concerns are thoroughly addressed.

 Collaborate with internal teams to resolve problems and enhance overall customer

satisfaction.

 Accurately document customer interactions, including actions taken, resolutions

provided, and any follow-up required.

 Adhere to department policies and HIPAA regulations to maintain confidentiality and

security of member information.

 Manage complaints, grievances, and appeals efficiently according to department

protocols.

 Assist in onboarding and training new staff, sharing knowledge and best practices.

 Complete required training promptly to stay current with procedures, systems, and

regulations.

 Consistently meet or exceed standards for quality, productivity, and adherence to

schedules.

 Participate in outbound call campaigns for welcome calls, enrollment verification calls, appointment scheduling,

retention efforts, and other health-related programs.

 Contribute to policy and procedure development related to customer experience.

 Stay updated on CMS, Medicare, and HIPAA regulations to ensure compliance and

provide accurate information.

 Utilize medical terminology and healthcare knowledge to assist members with inquiries.

 Adapt to changes in shifts, responsibilities, and operational needs as required.

 Facilitate member requests for provider changes, transportation, and other assistance.

 Maintain a positive attitude and practice excellent customer service principles.

 Perform other duties as assigned to contribute to the team and department’s success

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

 High School diploma or GED required.

 Associate degree (AA) degree (preferred).

 Minimum (2) or more years of direct customer service EXPERIENCE

 Knowledge of Medi-Cal, Medicare Managed Care Plans.

 Medical front office experience preferred.

PROFESSIONAL COMPETENCIES

 Strong communication skills (verbal and written).

 Highly organized with the ability to prioritize work to meet deadlines.

 Strong adaptability and openness to change.

 Knowledge of HIPAA regulations with a commitment to data privacy.

 Strategic skills in problem-solving, critical thinking, and innovation.

 Ability to collaborate effectively with business partners throughout the organization.

 Experience assisting members with Medicare Advantage or HMO, including referrals and authorizations.

 Outbound/inbound call center experience with a focus on problem-solving and escalation.

 Bilingual in English/Spanish or Vietnamese/English required.

 Proficiency in Microsoft Applications (Word, Excel, Outlook).

 Ability to multitask and prioritize tasks effectively.

 Flexibility to work varying shifts, including evenings and weekends.

LICENSURES AND CERTIFICATIONS

No licensures or certifications are required.

WORK ENVIRONMENT and ESSENTIAL PHYSICAL FUNCITONS:

Work Environment:

 Must be available for scheduling 7 days a week, including evenings, overnights, weekends, and holidays.

 Shifts may change based on operational needs; flexibility is essential.

Essential Physical Functions:

 Ability to work onsite in an open office setting, primarily sitting at a desk and working on a computer.

 Regularly required to talk, hear, stand, walk, sit, and use hands to handle or feel objects and controls.

 Frequently lifts/moves up to 10 pounds. Specific vision abilities include close vision and the ability to adjust focus.

EEO/AFFIRMATIVE ACTION STATEMENT

As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse group of employees committed to meeting the needs of Champion Payer Solutions/ Champion Health Plan, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

Job Type: Full-time

Pay: From $22.00 per hour

Benefits:

401(k)
Dental insurance
Flexible schedule
Health insurance
Paid time off
Vision insurance

Experience:

Managed care: 2 years (Required)

Language:

Spanish (Preferred)
Vietnamese (Preferred)

Ability to Commute:

Long Beach, CA 90815 (Required)

Ability to Relocate:

Long Beach, CA 90815: Relocate before starting work (Preferred)

Work Location: In person

Quick Apply

Refine Your Search

Claim Service Adjust jobs

Member Service Representative

Claims Adjuster Trainee

Telephone Claims Adjuster

Adjuster Trainee

Remote Customer Service/Sales Representative

Client Coordinator

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Audiologist - Omaha, NE

Sales Account Manager

Licensed Optician FT Troy, OH #320

Remote Mental Health Provider (LPC, LCSW, LMFT, LMHC)

BCBA Clinical Director - Alliance, Fort Worth

Licensed Optician

Licensed Optician FT Summerville SC #285

Jewelry Service Consultant

Remote Mental Health Provider (LPC, LCSW, LMFT, LMHC)

Property Claim Specialist

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Remote Mental Health Provider (LMFT)

Remote Mental Health Provider (LMFT)

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