Top 298 Managed care Jobs in Irvine, Ca

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
Regional Care Biller - Centralized Billing Office (CBO)
Pursue Health LLC —Irvine, CA
- $32 an hour
- Full-time
- Background check
- Customer service
- Office
- Health insurance
- Dental insurance
Quick Apply
Enrollment Representative
Champion Health Plan —Long Beach, CA
- From $23 an hour
- Overtime
- Background check
- Spanish
- HIPAA
- Health insurance
- Dental insurance
Quick Apply
8d
Lead Care Manager (At least 1 yr exp, Bilingual: English/Spanish a plus)
Nurturing Care —Orange County, CA
- $22 - $26 an hour
- Full-time
- Spanish
- English
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
Care Manager LCSW
Providence Health and Services —Mission Viejo, CA
- $43.39 - $67.37 an hour
- 8 hour shift
- Acute care
- Licensed Clinical Social Worker
- Inpatient
- Paid parental leave
- Paid holidays
8d
Managed Care Coordinator
CHOC Children's —Orange, CA
- $64,355 - $106,184 a year
- Full-time
- Microsoft Word
- Mid-level
- High school diploma or GED
3d
Collector I: Business Service-Managed Care
Hoag Health System —Costa Mesa, CA
- Full-time
- Customer service
- High school diploma or GED
- 1 year
- Employee discount
Medical Records Collector (Remote)
Molina Healthcare —Orange, CA
- $20.34 - $30.39 an hour
- Full-time
- Remote
- Microsoft Excel
- Administrative experience
- Driver's License
- Health insurance
Managed Care Network Coordinator - Managed Care - FT Days
University of California, Irvine —Orange, CA
- $97,000 - $182,200 a year
- Full-time
- Background check
- Microsoft Outlook
- 5 years
- Health insurance
- Retirement plan
Community Health Worker/Lead Care Manager in Placer County CA (Position is in Placer County)
Sowing Seeds Health Inc —Irvine, CA
- $25 - $30 an hour
- 8 hour shift
- Computer literacy
- Mid-level
- Office
- Paid training
- Mileage reimbursement
Quick Apply
UM Coordinator, Inpatient (Remote | Part-Time | Weekends | Pacific Time Required)
Alignment Healthcare USA, LLC —Orange, CA
- $41,472 - $62,208 a year
- Part-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- Customer service
Quick Apply
4d
Manager Business Services: Business Service-Managed Care
Hoag Health System —Costa Mesa, CA
- Hospital
- Mid-level
- Master's degree
8d
Principal Admitting Worker - ED Registration Irvine - F/T Evenings
University of California, Irvine —Irvine, CA
- $26.67 - $33.15 an hour
- Full-time
- Background check
- Spanish
- Customer service
- Health insurance
- Retirement plan
10d
Medical Case Manager, BHI Utilization Management - Covered California
CalOptima —Orange, CA
- Weekends as needed
- Background check
- LMFT
- Microsoft Outlook
- Tuition reimbursement
- Paid time off
Director of Managed Care
KabaFusion —Cerritos, CA
- $175,000 - $200,000 a year
- Full-time
- Microsoft Word
- Microsoft Excel
- Microsoft Outlook
- Paid holidays
- Disability insurance
Quick Apply
Discharge Planner
Garden Grove Hospital Medical Center —Garden Grove, CA
- $23.00 - $32.04 an hour
- Part-time
- Acute care
- LVN
- Hospital
- Health insurance
- Dental insurance
UM Coordinator, Inpatient (Remote | Pacific Time Schedule)
Alignment Healthcare USA, LLC —Orange, CA
- $41,472 - $62,208 a year
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- Customer service
Quick Apply
2d
Hearing Ambassador (Patient Care Coordinator)
NationsBenefits, LLC —Fountain Valley, CA
- Full-time
- Computer literacy
- High school diploma or GED
- Communication skills
- Opportunities for advancement
Quick Apply
1d
Principal Admitting Worker - ED Registration Orange - P/T Days
University of California, Irvine —Orange, CA
- $26.67 - $33.15 an hour
- Full-time
- Background check
- Spanish
- Customer service
- Health insurance
- Retirement plan
10d
Managed Care Analyst - Capitation Revenue
Memorial Health Services —Fountain Valley, CA
- $38.36 - $55.61 an hour
- 8 hour shift
- Microsoft Excel
- Mid-level
- Finance
- Health insurance

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managed care jobs near irvine, ca

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

managed care jobs in irvine, ca

Member Service Representative

Regional Care Biller - Centralized Billing Office (CBO)

Enrollment Representative

Lead Care Manager (At least 1 yr exp, Bilingual: English/Spanish a plus)

Care Manager LCSW

Managed Care Coordinator

Collector I: Business Service-Managed Care

Medical Records Collector (Remote)

Managed Care Network Coordinator - Managed Care - FT Days

Community Health Worker/Lead Care Manager in Placer County CA (Position is in Placer County)

UM Coordinator, Inpatient (Remote | Part-Time | Weekends | Pacific Time Required)

Manager Business Services: Business Service-Managed Care

Principal Admitting Worker - ED Registration Irvine - F/T Evenings

Medical Case Manager, BHI Utilization Management - Covered California

Director of Managed Care

Discharge Planner

UM Coordinator, Inpatient (Remote | Pacific Time Schedule)

Hearing Ambassador (Patient Care Coordinator)

Principal Admitting Worker - ED Registration Orange - P/T Days

Managed Care Analyst - Capitation Revenue

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