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IEHP

Member Services Representative, Bilingual

IEHP

. Provide Members with health plan education regarding Medi-Cal benefit coverage, coordination of benefits, and eligibility rules .

Posted 10/27/2026full-timeRancho Cucamonga • California • United StatesJunior💰 $23 per hourWebsite

Core Competencies

Role fit
Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in providing health plan education, resolving inquiries, and ensuring compliance with HIPAA regulations. Proficient in customer service, particularly in call center environments, with a focus on member satisfaction and effective communication.

Highest-signal resume keywords
Customer Service ExperienceBilingual CommunicationMedi-Cal Program KnowledgeCall Center ExperienceMicrosoft Office Proficiency

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills
Medi-Cal Benefit CoverageCall DocumentationTyping Minimum 35 WPMMember Satisfaction SurveysHealth Care Options Liaison
Soft Skills
Excellent Oral CommunicationProblem SolvingCollaborationFlexibilityGood Grammar and Spelling
Tools & Technologies
Microsoft Office SuiteWindows Based Programs
Certifications & Qualifications
High School Diploma or GED
Industry Keywords
HMO ExperienceManaged Care ExperienceHIPAA ComplianceMember ServicesTelephonic Translation

About the role

Key responsibilities & impact
  • Provide Members with health plan education regarding Medi-Cal benefit coverage, coordination of benefits, and eligibility rules
  • Meet IEHP and Member Services Call Center standards and policy requirements
  • Complete Member Services Training and participate in continuous training
  • Provide superior service and resolve caller inquiries at the first point of contact
  • Assist with primary care/facility assignments, selections, and changes
  • Support health care options liaison, health education advisory, and provider eligibility status requests
  • Educate Members, request materials, support programs, order ID cards, and help Members access services
  • Present cases to management and collaborate with other departments to resolve Member and Provider inquiries
  • Handle transportation, interpreter, referral, re-direction, Behavioral Health, and Pharmacy inquiries
  • Document calls accurately; complete Member Satisfaction Surveys and Assessments as needed
  • Intake Member grievances properly and timely
  • Coordinate telephonic translation when Members do not speak English or Spanish
  • Meet monthly key performance indicator goals
  • Protect PHI and comply with HIPAA and regulatory requirements
  • Authenticate callers and preserve Member confidentiality
  • Participate in LEAN process improvement projects and RIE Events/Huddles
  • Assist Members with self-service options
  • Track departmental trends and escalate information to management
  • Review call recordings and develop self-action plans to improve quality assurance scores
  • Maintain knowledge of other departments and Member Services workflows
  • Comply with IEHP Telecommuting Agreement and requirements

Requirements

What you’ll need
  • One (1) year of Customer Service experience analyzing and solving customer problems
  • High school diploma or GED required
  • Bilingual; identified bilingual team members must take a language proficiency assessment and receive a passing score
  • HMO or Managed Care Experience preferred
  • One (1) year call center experience in a customer service setting preferred
  • Medi-Cal program and benefit requirements experience preferred
  • Proficiency in Microsoft Office Suite and Windows based programs
  • Typing Minimum 35 wpm
  • Good grammar and spelling skills
  • Excellent oral communication skills
  • Availability for day, swing, and overnight shifts
  • Weekend and holiday coverage as needed
  • Flexible scheduling based on business needs

Benefits

Comp & perks
  • CalPERS retirement
  • 457(b) option with a contribution match
  • Generous paid time off- vacation, holidays, sick
  • State of the art fitness center on-site
  • Medical Insurance with Dental and Vision
  • Paid life insurance for employees with additional options
  • Short-term, and long-term disability options
  • Pet care insurance
  • Flexible Spending Account – Health Care/Childcare
  • Wellness programs that promote a healthy work-life balance
  • Career advancement opportunities and professional development
  • Competitive salary with annual merit increase
  • Team bonus opportunities