Our Member Services Coordinator (MSC) will assist and respond to all Medicare (to include MAPD and DSNP) members’ requests, questions, and concerns in a timely and professional manner; to function as a liaison/service coordinator between Central Health Medicare Plan, members, and contracted IPAs/providers when applicable.

Duties and Responsibilities:

• Be at work/cubicle timely based on the work schedule on file and ready to handle incoming customer calls and assignments professionally; must follow company and department guidelines for all time off/vacation/overtime requests, especially during enrollment season
• Provide general telephone customer service assistance to both MAPD and DSNP members and providers in a professional manner and provide precise and timely responses;
  • Inform Member Services Supervisor on any questions or issues encountered over the phone with members, and any/all member questions or operation related questions before supervisory personnel provide further direction
  • Assist with contacting/faxing provider offices when appropriate as part of the general assistance
  • Check all voicemail and emails timely
• Write detailed and precise member phone log for each call received and called out and all department assigned functions which require documentation; select the appropriate call category accurately and ensure the consistency of all call log entries; notify any supervisory personnel when help is needed
• Assist with member enrollment and disenrollment outbound contact/research and maintenance of member files, hard copy and all telephone communication must be kept in system and in member file.
• Coordinate the assembling and mailing of welcome packets, ID cards, and all other applicable letter/notices to members when is needed
• Identify and research issues and requests of current members. Communicate both verbally and in writing in a clear and concise manner based on the current policies and guidelines of CMS and Central Health Medicare Plan.
• Assist with D-SNP member calls as appropriate; CHMP MSC guides DSNP members via telephone when necessary to contact his/her social worker or Medi-Cal
• Plans (FFS or HMO managed care) and provides all available resources such as toll free numbers for local SSA office, Medi-Cal offices, and other community contact phone numbers; MSCs do not assist with share of cost issues, balance billing, or eligibility reinstatement directly but if necessary, MSC can assist DSNP members via 3-way call to appropriate entities to receive additional assistance.
• Responsible for the intake of member grievances, appeals, coverage determination (including pharmacy), and general complaints expressed verbally or in writing;
• Coordinate with the handling Level 3 Coordinator and/or Member Services
• Supervisor in ensuring the timely filing of all cases. Carefully document and file the receipt of issues and action (s) taken from all responsible parties; Follow up of each grievance/appeal/determination case with QM Department until cases reach resolution/closure; Contact member and provider regarding Plan’s decision on requests/issues when applicable
• Be familiar with Department P & P, Plan benefits, internal guidelines, applicable
• CMS regulatory references, and other applicable department resources provided by supervisory and management personnel; attend all in service and training sessions provided in house and be able to demonstrate good understanding of all such training
• Responsible to complete and handle assigned logs, tasks, member related surveys, and assist with all department projects as needed
• Assist Community Outreach and Education Department and Wellness Centers with event RSVP and other assignments as needed, including attending off site member orientation or member presentation
• Develop a working relationship with the other departments within the organization
• Cooperate with supervisory and management personnel on all auditing related criteria, department policies and guidelines, and implement changes when needed to achieve department goals

Qualifications:

• Must have at least High School diploma
• Bilingual and fluent in Cantonese - required, language will be tested for fluency
• Previous experience in customer service preferred 
• Computer skills to include word processing and excel
• Must have strong verbal, written, and interpersonal communication skills
• Must have excellent customer service skills and demonstrate respect, patience, and helpfulness with customers and co-workers
• Must be responsible, detail-oriented, and professional
• Must understand and comply with HIPAA (patient privacy) regulations
• Prior experience in a customer service environment and/or familiarity with the medical/healthcare industry is preferred but not required

For individuals assigned to a location(s) in California, Bright Health is required by law to include a reasonable estimate of the compensation range for this position.  Actual compensation will vary based on the applicant’s education, experience, skills, and abilities, as well as internal equity. A reasonable estimate of the range is $17 to $25 hourly.

Additionally, employees are eligible for health benefits; life and disability benefits, a 401(k) savings plan with match; up to 21 days of PTO, 10 paid holidays, plus 2 floating holidays per year; and a lifestyle spending account.