Johnson Service Group (JSG) is seeking a
Bilingual Member Service Representative - Enrollment- Medi-Cal for a healthplan partner in Orange, CA.
This is an onsite position.
Bilingual in English and (Arabic, Farsi, Chinese, Korean, Russian, Spanish, Vietnamese).
Work schedule: Monday- Friday
Pay rate: $24-32 per hour DOE
Duties & Responsibilities:
- Program Support
- Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
- Coordinates specialized processes, including eligibility analysis, strategic provider assignments, age restriction and complex condition member administration/monitoring and floor audits for the Medi-Cal program.
- Assists with completing various members requests, such as Change of Health Network Requests, primary care provider (PCP) change requests and data correction forms.
- Responds to questions and interprets policies and regulations.
- Prepares materials (e.g., letters/surveys, etc.) and coordinates data files to arrange for mail merge of materials as applicable.
- Assists with ensuring processes are accurate and compliant with the regulatory requirements by maintaining and documenting process workflows, desktop procedures and policies.
- Represents the Medi-Cal program on projects or as a liaison within or outside company.
- Facilitates communication on specialized topics.
- Prepares reports and creates reporting tools; performs special reconciliation procedures, including Excel sorts and mergers, filters and compiling reports and Access database procedures.
- Acts as liaison between the Enrollment department and other Customer Service staff.
- Supports with quality assurance audits to validate the accuracy of Protected Health Information Appointment of Representative (PHI/AOR) and Acceptance Letter updates processed by other staff members.
- Conducts outreach to members for various Enrollment department reasons.
- Conducts outreach to health insurance carriers to verify potential Other Health Coverage (OHC).
- Assists with processing mailed-in member surveys submitted by manually updating members' profiles with various updates, including demographic changes, other health coverage, and address changes.
- Responsible for opening, sorting, reviewing, and tracking of returned mail by maintaining an organized and accurate log to ensure timely submission for monthly text campaigns.
- 5% - Other
- Completes other projects and duties as assigned.
Minimum Qualifications:
- High school diploma or equivalent PLUS 1 year of experience of eligibility and/or reconciliation required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
Preferred Qualifications:
- Health insurance experience (Medi-Cal).
- Prior experience interacting with regulatory agencies, including Department Health Care Services (DHCS) and Department of Managed Health Care (DMHC) and practices related to Medi-Cal.
Experience in a Health Maintenance Organization (HMO), managed care or Medi-Cal setting.
- Customer Service experience.
- Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Russian, Spanish, Vietnamese).
Knowledge & Abilities:
- Develop rapport and establish and maintain effective working relationships with company leadership and staff and external contacts at all levels and with diverse backgrounds.
- Work independently and exercise sound judgment.
- Communicate clearly and concisely, both orally and in writing.
- Work a flexible schedule; available to participate in evening and weekend events.
- Organize, be analytical, problem-solve and possess project management skills.
- Work in a fast-paced environment and in an efficient manner.
- Manage multiple projects and identify opportunities for internal and external collaboration.
- Motivate and lead multi-program teams and external committees/coalitions.
- Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
JSG offers medical, dental, vision, life insurance options, short-term disability, 401(k), weekly pay, and more. Johnson Service Group (JSG) is an Equal Opportunity Employer. JSG provides equal employment opportunities to all applicants and employees without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, marital status, protected veteran status, or any other characteristic protected by law. #D800
