• Answer all daily telephone calls from members, providers, health plans, insurance brokers, collection agents and hospitals • Collect Elicit information from members/providers including the problem or concerns and provide general status information • Verify authorization, claims, eligibility, and status only • All calls carefully documented into Company’s customer service module & NMM Queue system • Member/Provider Service/Representative assists Supervisor and Manager with other duties as assigned • Member outreach communications via mail or telephone • Assist Member appointment with providers • Resolve walk-in member concerns • Able to provide quality service to the customers • Able to communicate effectively with customers in a professional and respectful manner • Maintain strictest confidentiality at all times • Specialist termination notifications sent to members • Urgent Medicare Authorization Approval – Notification to Medicare members • Transportation arrangement for Medicare & Medi-Cal members • Outreach Project Assignments • Conduct 3 way conference call to Health Plan with member • Conference call with Providers – Appointments, DME, • COVID – 19 related questions (Tests & Vaccines) • Direct Member Reimbursement (DMR) • Eligibility – Demographic changes: Address/Phone/Fax Changes/Name change • Escalated calls from providers/members • Member bills • Miscellaneous calls • Pharmacy – Drug/medication pick up and coverage • Provide authorization status for Hospital /CM Dept • Self-Referral Request for Medicare • Track Mail Packages/ Certified mail status • Translations – Spanish / Chinese • Urgent Care / locations/ operations hours • Assist Case Management on CCS – age in 21 years for change of PCP from Pediatrics to FP/IM • Assist Marketing on email inquiries • Assist PR/ Elig – Members assigned to wrong PCP/with no PCP status • Assisted UM / Medical Directors on urgent member appointment from escalated cases • Authorization status response call back • Benefits – return call once information is obtained / verified • Complaints/Grievances – return calls once resolution is obtained • DME – Translation support in Spanish and Chinese to confirm item / appointment set up for DME department • Eligibility – return call to providers/labs when member is added to system while waiting at the office. • Member Survey – Annually: every 4thquarter • Outreach project from internals – QCIT • Resolve walk in members concerns • Specialist Termination notification sent to members • Transportation arrangement for Medicare / Medi-Cal members • Voice mail – return calls back to callers • Assist to contact new members/IPA member transfer on new PCP assignment as needed • Work group discussions on work status/progress on new member/IPA transfer • Update call log and provide daily/weekly status as needed • Facilitate members with complex pre-existing conditions, medications, PCP/SPC network reviews • Conference call with PCP selection / change • Help member to identify member bill status, connect provider with on billing and claim submission • Responsible for experience of the membership associated with new member/IPA transfer • Responsible for to interact with Health Plan’s Customer Service Team to serve new member/IPA transfer • Problem Solving complex cases/ brain storm with MS management team for resolution • Other duties as assigned