Robert Half Medical Customer Service Rep in Irvine, California
Description Position is responsible for answering a high volume of incoming and outgoing calls and responding to all communications coming to Member Services in the form of email, fax, letters, and phone calls. Timely responses to all member communication are essential. Must effectively prioritize and flex the workload as new communication and task are submitted. This role is a part of the Member Services department and reports to the Member Services Supervisor.
Typical essential functions include but are not limited to Explaining the plans benefits, procedures, & services to:
o Providers and employers requesting benefits, eligibility, authorization for outpatient surgery, Member’s claims concerns, or referral requests to other network providers Hospital admission and pre-admit authorization requests
o Members with eligibility issues, COBRA, claims & other concerns regarding their coverage
o Pharmacies with eligibility issues, drug authorization, drug co-pays, research of RX claims issues
o Maintain follow-up on phone logs, claim research, eligibility, medical, dental, vision, and prescription plan issues
o Review member service procedures, publications, daily for one-call member resolution
o Maintain member satisfaction and retention via rapport building and proper identification of member, employer, provider, and service representative needs
o 1 or more years of healthcare service, claims, benefits related experience related to position
o Knowledge of medical terminology.
o High School diploma required; college level course work preferred in Healthcare Administration.
o Proficient in Outlook, Word, One Note, and Excel
o Experience in working the following fields: Healthcare Benefits plans, Billing and Coding, Customer Service call center experience and able to answer a minimum of 50+ calls per day.
o Must be fluent English/Spanish (reading, writing, and speaking)
Communication, professional written and verbal skills
o Active Listening and verbal skills: concentrates, understands conversations, retention, delivering feedback and organization’s message
o Accurate and fast professional typing skills, timely response to high volume of emails, faxes, etc.
o Communicates with everyone in a positive way and delivers feedback constructively
o Providing details and clear notes of necessary compliance documents, trainings, and meetings
Customer Focused, Member-Centric
o Integrity and Trust - provides communication between departments, demonstrating credibility, trust, and support. Maintains HIPPA compliance, documents and projects in trust and integrity on behalf of United Ag, handles confidential information with discretion, trust, and integrity. Maintains discretion and confidentiality in relationships with all audiences
o Member-centric: assist members, groups, vendors and teams with our forms, projects, and processes. Dedicated to meeting the expectations and requirements of internal and external members. Acts with member first mentality. Establishes and maintains effective relationships with members and gains their trust and respect.
o Composure: Levelheaded, balanced and calm under pressure, mature, not easily frustrated, handles stress well
o Compassion: Genuinely cares about team and members, ready to help, sympathetic and empathic towards others Requirements Customer Service
Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.
Robert Half puts you in the best position to succeed by advocating on your behalf and promoting you to employers. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity – even on the go. Download the Robert Half app and get 1-tap apply, instant notifications for AI-matched jobs, and more.
Questions? Call your local office at 1.888.490.4154. All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals. Visit https://roberthalf.gobenefits.net/ for more information.