Customer Service Representative - Health Plan Services

This is a benefitted Full Time, Day Shift position with a Monday-Friday schedule and 8AM-4:40PM or 8:30AM - 5PM shift (rotated), located at the 4S Ranch Business Services office in Rancho Bernardo. Staff meetings are held once a month until 7pm. This position is partial remote after training with one a month in the office (the last Thursday).

Why join Scripps Health?

At Scripps Health, your ambition is empowered and your abilities are appreciated:

• Nearly a quarter of our employees have been with Scripps Health for over 10 years.
• Scripps is a Great Place to Work Certified company for 2025.
• Scripps Health has been consistently ranked as a top employer for women, millennials, diversity, and as an overall workplace by various national publications.
• Becker's Healthcare ranked Scripps Health on its 2024 list of 150 top places to work in health care.
• We have transitional and professional development programs to create a learning environment that enables you to thrive in your specific field as well as in your overall career.
• Our specialties have been nationally recognized for quality in areas such as cardiovascular care, oncology, orthopedics, geriatrics, obstetrics and gynecology, and gastroenterology.

Join a wonderful team as a Member Service Representative in our Scripps Health Plan Services department at our 4S Ranch Business Services office. In this position, you will play an important role in supporting our patients' incoming calls in a call center environment.

Under general direction, primary responsibilities will include the following:

• Providing customer service to plan members and providers by answering complex benefit questions, resolving issues and educating customers.
• Receiving inbound telephone, internet and written inquiries from members and providers regarding covered benefits, claims, referrals and eligibility.
• Making outbound telephone and email contacts to members and providers to provide education and facilitate issue resolution.
• Managing claim checks, checking referral status', and managing member calls.
• Managing member appeals and grievances.
• Other special projects as assigned.

Required Education/Experience/Specialized Skills:

• 3 or more years of customer service experience.
• 1 or more year of experience in a call center environment.
• Strong written, verbal and listening communication skills.
• Strong problem-solving skills.

Preferred Education/Experience/Specialized Skills/Certification:

• Managed care experience.
• Knowledge of EPIC Tapestry.
• Health Plan experience.
• Health care administration.