Member Services Agent

Description

UCLA Health is seeking a compassionate and service-driven Member Services Agent to support our patients and providers by delivering exceptional customer service over the phone. In this role, you will serve as the first point of contact for members, helping address inquiries, resolve concerns, and support access to care. You'll work closely with internal teams, health plans, and providers to ensure a smooth and positive patient experience.

Key Responsibilities

Answer incoming calls with professionalism, courtesy, and adherence to departmental scripts and service standards

Respond to member and provider inquiries regarding benefits, eligibility, referrals, and billing issues

Document all interactions accurately in the managed care information system

Verify member eligibility, provider participation, and referral history

Coordinate warm hand-offs and connect members with appropriate departments

Research and resolve moderately complex issues, escalating when necessary

Complete outbound follow-up calls to ensure resolution and member satisfaction

Maintain performance standards related to call metrics, quality, and productivity

Ensure compliance with HIPAA, privacy standards, and UCLA Health policies

Collaborate with internal staff to support continuous process improvement

Salary Range : $ 30.36 - $

43.49 Hourly

Qualifications

Required :

• High School Diploma, GED, or equivalent
• Minimum 4 years of related experience or training
• Demonstrates advanced customer service skills, exercising empathy and professionalism when resolving escalated or sensitive member issues.
• Ability to independently research, analyze, and resolve complex member inquiries while adhering to departmental policies.
• Familiarity with EPIC Tapestry, CRM systems, and other managed care information systems
• Proficiency in documenting detailed case information and providing clear follow-up communications to members and providers.
• Demonstrates ability to prioritize competing tasks, meet performance standards, and manage high call volumes effectively.
• Proficiency with Microsoft Office applications (e.g., Word, Excel, Outlook) and experience navigating multiple systems simultaneously.
• Ability to identify trends or recurring issues and escalate them to supervisors or management for resolution.
• Demonstrates strong problem-solving skills and the ability to work with minimal supervision when appropriate.
• Ability to handle confidential patient and provider information in compliance with HIPAA and organizational standards.
• Skill in working collaboratively with internal teams, physicians' offices, and health plan representatives to achieve positive outcomes.
• Strong written and verbal communication skills to convey information clearly and accurately.
• Ability to work unit hours of 8 : 00 AM - 5 : 00 PM PST, with occasional overtime as needed.
• Demonstrates reliability, adaptability, and commitment to achieving team and organizational customer service goals.