Member Service Representative

French Camp or Modesto

Health Plan of San Joaquin (HPSJ) is a growing, dynamic, community-based managed care health plan that offers commercial products and government sponsored programs in a three county service area. We are located in French Camp, which is just south of Stockton, California in the San Joaquin Valley.  We offer a supportive work environment, stability, and competitive pay and benefits, including employer paid CalPERS. 

Summary

Under general supervision, responds to and resolves a variety of inquiries, requests and issues from external customers.

Education and Experience: 

Required

• High school diploma or equivalent
• At least one year experience in a clerical, administrative or customer service role
• Experience in handling heavy call volume (50-100 calls per day)

Preferred

• At least one year of post high school education
• Experience in health care or related field
• Experience as a member service representative or similar

License, Certification, Registration:

Required

• none

Knowledge, Skills, and Abilities:

Required

• Basic knowledge of managed care, Medi-Cal and/or Medicare programs.
• Basic knowledge of medical policy benefits and exclusions.
• Strong interpersonal skills, including the ability to interact effectively with diverse individuals at all levels inside and outside of HPSJ
• Strong oral and written communication skills, with the ability to communicate effectively and professionally with individuals inside and outside of HPSJ, explain complex information and document according to standards.
• Ability to use tact and diplomacy to diffuse emotional situations.
• Ability to handle heavy call volume 50-100 calls daily (including documentation and resolution).
• Strong listening skills.
• Ability to read, understand and apply complex written guidelines, instructions and other materials.
• Ability to understand and follow oral and written instructions.
• Good problem solving and analytical skills.
• Good organizational skills.
• Type 45 WPM with 90%.
• Basic Word, Excel and Outlook skills.
• Basic arithmetic skills.
• Ability to work effectively as part of a team.
• Ability to speak and be understood in English.
• Ability to treat confidential information with appropriate discretion.
•  
• Some positions require proficiency (as defined by HPSJ’s Cultural and Linguistics Program) in one of HPSJ’s threshold languages.

Preferred

• ICD and CPT coding.
• Medical terminology.

Essential Functions:

• Provides information on benefits, eligibility, claims and authorizations over the phone and in person.
• Researches reported issues related to claims and authorization status; forwards information to appropriate department for resolution.
• Tracks issues to ensure resolution within mandated time frames.
• Researches and resolves complex eligibility issues.
• Documents calls and logs into appropriate system.
• Bilingual representatives provide onsite interpretive/translation services to members.

Please visit our website at www.hpsj.com

To be considered for this position, please submit application, equal employment identification form and resume

with job title to APP4HPSJ@hpsj.com or fax to 209 461 2567

For internal candidates, please submit an internal job application to Human Resources

Health Plan of San Joaquin is an Equal Opportunity/Affirmative Action Employer