Member Services Specialist ( Data Management )

Position Summary:

Provides data analysis, management and reporting for various requests that come from within the Customer Service Department. Collect, input and disseminate accurate descriptive data. Effectively use Cisco Historical Reports, Cal Optima dashboards, graphs and tables to convey analysis and summarize results.

Essential Duties and Responsibilities include the following:

• Enters information in the systems to ensure accurate reporting
• Ensures tracking of all key indicators to assist in managing the department’s performance.
• Perform statistical analysis, interpretation of data and presentation of high quality reports for Health Plan  reporting
• Establishes and maintains effective, consistent reporting to management as needed.
• Provides recommendations for information and reporting initiatives that support department.
• Ensures all processes are completed in a timely manner.
• Performs random audits on reports to validate accuracy, delivery and usage.
• Attends administrative meetings and provides information to staff as appropriate.
• Develops and fosters a customer satisfaction focused, service mentality within department to strengthen and build relationships with other internal departments such as HPN, UCMG, Quality Management and CS Management
• Communicates a balanced view of information in relation to other business functions.
• Receives incoming calls involving multiple issues from members, Health Plans and providers maintain quality and productivity standards
• Trains new customer service employees and answers questions relating to eligibility, referrals, provider availability, claims status and department procedures
• Handle a multitude of assignments and prioritize work in order to maintain workflow
• Attend daily and weekly meetings with supervisors and department manager and provide statistic reports.
• Researches and resolves routine and complex issues relating to services provided by RMG,LMG GCMG and ADOC. This can include eligibility updates, referral status, claim status, and general information.
• Maintain a daily production of 35 calls or more

Historical Report

•  Run reports daily, weekly, monthly and quarterly

Contact Service Queue

• This reports tracks the daily and monthly abandonment rate to all LOB
• Determines total calls answered as well as a total of calls abandoned
• Breaks down each queue and LOB and the quantity of calls were handled based on service
• Gives the ASA (average speed of answer)
• Talk time determines the average handle time of the calls

Agent Call Summary

• Determine how many calls each customer service representative takes daily
• Gives that amount of incoming calls and gives an accurate count to determine whether the reps are meeting production of a minimum of 65 calls.
• Send out weekly production by color coordinating staff production. Red not meeting, yellow almost meeting and green meeting production. Same applies for incidents
• Contacts Service level priority
• Reports Medical, OCC and OneCare percentage average of the service level e.g. 80% and above is the

Agent Detailed Report

• Report determines what type of call is being handled by individual representative.
• Detailed report on the duration of the call as well as the hold time on the call.
• Details where the call came from and where it ended up.

 Incident Report (Generated by RMGReports)

• Gives representatives individual count on how many calls were documented that day.
• Captures the type of call and breaks down the subtype of the call
• Reports Authorization, Claim or General call volume

 HPN RMG Report (Generated by RMGReports)

• Individual production of HPN employee calls.
• Captures the type of call and breaks down the subtype of the call

Dashboard Report (UCMG and HPN)

• Total calls per month
• Average Speed of Answer (ASA) for the month
• Service level for the month
• NEMT
• Abandonment Rate

QI Reports (Member, Provider and HPN Queues)

• Total calls per month
• Average Speed of Answer (ASA) for the month
• Calls Abandoned
• Average Talk Time
• Abandonment Rate

The pay range for this position at commencement of employment is expected to be between  $20 - $22 per hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

Full Time Position Benefits:

The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

Health and Wellness:

• Employer-paid comprehensive medical, pharmacy, and dental for employees
• Vision insurance
• Zero co-payments for employed physician office visits
• Flexible Spending Account (FSA)
• Employer-Paid Life Insurance
• Employee Assistance Program (EAP)
• Behavioral Health Services

Savings and Retirement:

• 401k Retirement Savings Plan
• Income Protection Insurance

Other Benefits:

• Vacation Time
• Company celebrations
• Employee Assistance Program
• Employee Referral Bonus
• Tuition Reimbursement
• License Renewal CEU Cost Reimbursement Program
• Business-casual working environment
• Sick days
• Paid holidays
• Mileage

Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.

Education and / or Experience:

• High School Graduate or equivalent required.
• 3 year experience in medical office, related field, including customer service duties
• Ability to deal responsibly with matters of a confidential nature.
• Ability to prioritize work in order to meet daily deadlines.
• Must have excellent communication skills, both verbal and written.
• Ability to read, write and understand the English language.
• Pleasant telephone manner.
• Working knowledge of MS Word.
• Working knowledge of MS Excel.
• Working knowledge Outlook (email & calendar)
• Working knowledge of Cisco phone system
• Ability to operate PC based software programs or automated data base management systems
• Thorough knowledge of company internal policies and procedures relating to service, medical management, eligibility and claims.
• Training experience in handling sensitive situations for members