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Member Relations Representative - Full Time, Days at Prospect Medical Systems - CA in Orange, California

Posted in General Business 30+ days ago.

Type: Full-Time

Job Description:

Member Relations Representative - Full Time, Days

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

The Member Relations Representative is responsible for acting as a liaison between members, health plans, and physicians. Individuals are required to perform at minimum 120 outbound attempts per day to Medi-Medi, Medicare, Commercial, POS and Medi-Cal members who are existing members with enrollment errors or are identified as potential terminations and other services necessary to ensure member healthcare satisfaction, wellness, and retention is accomplished.

Job Responsibilities/Duties

  • Complete all outbound retention effort campaigns as assigned
  • Complete all inbound retention calls.
  • Track outcome of all retention efforts
  • Assist with member inbound calls as needed.
  • 100% thorough documentation of every call.
  • Thoroughly verify HIPAA requirements to ensure account accuracy.
  • Follow-up on all open issues.
  • Communicate recurring issues and trends to management.
  • All other duties as assigned.


Minimum Education: Bachelor's Degree preferred. High School Diploma or equivalent required.

Minimum Experience: A minimum of two years of customer service experience in a call center environment required. A minimum of two (2) to three (3) years of IPA/HMO experience. Ability to project excellent customer service, negotiation, and conflict resolution skills via telephone in a fast-pace environment while maintaining a professional demeanor. Bi-lingual preferred. Advanced working knowledge in Microsoft Programs (PowerPoint, Word and Excel). Ability to multi-task, prioritize, and work in a fast pace environment. Knowledge of IPA/HMO. Proficiency in Microsoft Office Excel and Outlook applications.

Req. Certification/Licensure: None.

Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:

  • Company 401K
  • Medical, dental, vision insurance
  • Paid time-off
  • Life insurance

Prospect Medical Systems has a zero-tolerance policy regarding the use of drugs and alcohol. Our Company is committed to maintaining a productive, drug free workplace that keeps employees and patients safe from harm. For this reason, we require applicants to pass a screening for drug use as a condition of employment. This includes: alcohol, marijuana, cocaine, opiates and methamphetamines.

How to Apply

To apply for this role, or search our other openings, please visit and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law:

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