Member Service Representative (Remote)
IEHP
Rancho Cucamonga
- Delivered expert-level support in a high-volume call center, assisting members and providers with complex inquiries related to claims, prior authorizations, and eligibility within a managed care framework.
- Accurately documented all interactions using the MediTrac system, ensuring complete records for compliance, tracking, and follow-up.
- Guided members through health plan enrollment, benefit utilization, and claims resolution, improving access to care and enhancing the member experience.
- Educated members on available wellness programs, preventive services, and in-network resources to promote proactive health management.
- Acted as a liaison between providers and internal departments, routing inquiries to Utilization Management, Claims, or Provider Relations as appropriate.
- Ensured strict adherence to HIPAA and organizational compliance standards while handling sensitive health information.
- Maintained strong working knowledge of Medicaid, Medicare, and commercial managed care policies.
- Consistently met or exceeded departmental performance targets for call quality, resolution time, and customer satisfaction.