Top 4445 Member service representative Jobs in California

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
Teller (Senior Member Service Representative)
Patelco Credit Union —Dublin, CA
- $29 an hour
- Full-time
- Mid-level
- Office
- High school diploma or GED
- Paid holidays
- Health insurance
Member Services Representative
HIGH DESERT MEDICAL CORP, A MEDICAL GRP —Lancaster, CA
- $23.58 - $31.43 an hour
- Full-time
- Spanish
- High school diploma or GED
- Entry level
- Paid time off
- Parental leave
Quick Apply
Member Service Representative Level 1 (Pleasanton, CA)
BeneSys, Inc. —Pleasanton, CA
- $34.12 an hour
- Full-time
- Microsoft Word
- Basic math
- High school diploma or GED
- Paid jury duty
- AD&D insurance
Quick Apply
Patient Services Representative, Urology
Sutter Health —San Francisco, CA
- $32.16 - $45.02 an hour
- 8 hour shift
- Microsoft Outlook
- Writing skills
- High school diploma or GED
On-Site Customer Service Representative - Mission Viejo, CA
Sharecare —Mission Viejo, CA
- $24 an hour
- Full-time
- Microsoft Outlook
- Computer literacy
- HIPAA
Customer Service Representative, CC
Partnership HealthPlan of California —Fairfield, CA
- $29.95 - $35.19 an hour
- Full-time
- Spanish
- Mid-level
- Administrative experience
Patient Access Representative II
Sutter Health —San Francisco, CA
- $35.08 - $49.10 an hour
- 8 hour shift
- Hospital
- Computer literacy
- Writing skills
Medical Office Rep
Dignity Health Medical Group —Elk Grove, CA
- $25.00 - $34.33 an hour
- Full-time
- High school diploma or GED
- Clinic
- Typing
1d
Clerk
Partnership HealthPlan of California —Fairfield, CA
- $25.87 - $30.40 an hour
- Full-time
- Word processing
- Office
- High school diploma or GED
Patient Services Representative 2
UC Davis Health —Sacramento, CA
- $27.31 - $33.88 an hour
- Weekends as needed
- Background check
- Word processing
- Writing skills
- Continuing education credits
- Paid holidays
Patient Service Representative III
University of California, Riverside —Riverside, CA
- $61,282.80 - $87,821.28 a year
- Overtime
- HIPAA
- Mid-level
- 3 years
- Health insurance
- Dental insurance
Senior Patient Service Rep - Fair Oaks (Pasadena)
Cedars-Sinai —Pasadena, CA
- $24.65 - $38.21 an hour
- 8 hour shift
- Mid-level
- Outpatient experience
- High school diploma or GED
Patient Access Representative
Sutter Health —San Francisco, CA
- $32.30 - $43.34 an hour
- 8 hour shift
- Hospital
- Computer literacy
- Writing skills
8d
Member Service Representative (Part-Time) - Inglewood
Navy Federal Credit Union —Inglewood, CA
- $23.75 - $27.55 an hour
- Part-time
- Research
- Office
- Communication skills
- Referral program
8d
Patient Service Representative II, Revenue Cycle
Sutter Health —Santa Barbara, CA
- $25.68 - $35.94 an hour
- 8 hour shift
- Microsoft Outlook
- Writing skills
- High school diploma or GED
Patient Services Representative II
Sutter Health —San Francisco, CA
- $31.28 - $43.78 an hour
- Weekends as needed
- Microsoft Outlook
- Writing skills
- High school diploma or GED
2d
Patient Access Representative, Infusion Center
Sutter Health —San Francisco, CA
- $35.08 - $49.10 an hour
- 8 hour shift
- Hospital
- Computer literacy
- Writing skills
Insurance Senior Client Service Representative - Property & Casualty
CMR Risk & Insurance Services, Inc. —San Diego, CA
- $71,000 - $90,000 a year
- Full-time
- Hybrid work
- Microsoft Excel
- Microsoft Outlook
- Computer literacy
- Health insurance
- Dental insurance
Quick Apply
Insurance Customer Service Representative - Mandarin Speaker Required
State Farm Agency —Hacienda Heights, CA
- $40,000 - $60,000 a year
- Part-time
- English
- Office
- Communication skills
- Health insurance
- Paid time off
Quick Apply

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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

member service representative jobs in california

Member Service Representative

Teller (Senior Member Service Representative)

Member Services Representative

Member Service Representative Level 1 (Pleasanton, CA)

Patient Services Representative, Urology

On-Site Customer Service Representative - Mission Viejo, CA

Customer Service Representative, CC

Patient Access Representative II

Medical Office Rep

Clerk

Patient Services Representative 2

Patient Service Representative III

Senior Patient Service Rep - Fair Oaks (Pasadena)

Patient Access Representative

Member Service Representative (Part-Time) - Inglewood

Patient Service Representative II, Revenue Cycle

Patient Services Representative II

Patient Access Representative, Infusion Center

Insurance Senior Client Service Representative - Property & Casualty

Insurance Customer Service Representative - Mandarin Speaker Required

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