Healthcare Member Services Representative (Bilingual â Tagalog)

Location: Alameda, CA 94502 (Onsite)

Schedule: Monday–Friday, 8:00 AM–5:00 PM Pay:$28.61/hr Summary Now hiring aMember Services Representativeto support a high-volumehealth plan call centerand member support team. This Member Services Representativerole is ideal for a bilingual customer service professional who can handle inbound/outbound calls, resolve complex member issues, and document accurately in aCRM system. If you have call center experience and enjoy helping members navigate benefits and healthcare services, this Member Services Representativeopportunity offers steady weekday hours in an onsite Alameda location.

Responsibilities: Answer high-volume inbound/outbound calls and provide excellent customer service Respond to member communications via phone, email, chat, letters, and fax Assist with questions on health plan benefits, eligibility, claims, authorizations, pharmacy, and plan services De-escalate dissatisfied callers and drive first-call resolution when possible Research issues across multiple systems/databases and coordinate internal follow-up when needed Document all interactions clearly and consistently in CRM and electronic databases Support member navigation of self-service tools (member portal/online resources) Coordinate with internal teams (claims, enrollment, pharmacy, authorizations, grievance/appeals, network) to resolve issues Track, document, and resolve exempt grievances within required timelines Maintain confidentiality and compliance with regulatory and contractual standards Qualifications Bilingual Tagalog/English required(must pass proficiency exam at required score) High school diploma/GED required; Bachelor's degree or equivalent experience preferred 1+ year customer service experience (call center experience strongly preferred) Knowledge of managed care, Medi-Cal/health plan operations, eligibility, benefits, or authorizations is a plus Strong communication, active listening, time management, and problem-solving skills Comfortable with multi-monitor data entry, headsets/phones, and CRM documentation Able to work 100% onsite in Alameda, CA