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Member Service Team Lead in Cypress, CA at Beacon Health Options

Date Posted: 12/6/2018

Job Snapshot

Job Description

About the Position:

We are currently seeking a dynamic Member Services Team Leader to join our team at our office in Cypress, CA!   The Member Services Team Leader role will provide additional hands on assistance to all Member Services Representatives. This role will bring extensive knowledge of all Beacon related products and protocol related to Beacon/CHIPA claims, Provider Relations, and all Member benefit information.  In addition, the Member Services Team Leader will also be responsible for monitoring Member Services Staff’s breaks, lunches, After Call Work (ACW), and Average Handle Time (AHT).  Primary focuses are: ensuring that Member Service Representatives are providing accurate and all relevant info to Members and Providers in a timely fashion as established by the Member Services Department Standards. The Member Services Team Leader will also assist with handling claims tickets for resolution and with handling incoming calls during periods of high call volume. 

Position Responsibilities:

  • Answers internal & external calls.
  • Makes outbound calls to customers or clients about detailed account information.
  • Identifies and prevents potential member and provider concerns.
  • Reports all new and reoccurring issues to management.
  • Proactively assists Member Service Representatives with questions and escalated calls.
  • Produces a weekly claims recap that contains updates, changes, issues on claims for Member Services
  • Documents claims actions by completing forms, reports, logs, and records.
  • Ensures legal compliance by following company policies, procedures, guidelines, as well as state and federal insurance regulations.
  • Maintains quality customer service by following customer service practices, responding to customer inquiries.
  • Stays current with system, product, and service plans and participate in educational opportunities.
  • Enhances department and organization reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments.
  • Resolves complex claims issues from members and providers
  • Assists in monitoring Member Services Representatives queues to ensure adequate phone coverage.
  • Assists with training new employees.
  • Acts as a mentor to junior team members by leading by example and guiding with a sense of integrity and team work.
  • Assists management with identifying opportunities for staff improvement, high performing team members, and training needs of team members.
  • Assist team members and offers suggestions to improve processes, culture, or work environment.

Position Requirements:

Education: High School diploma or GED required, Bachelor’s degree preferred.


Relevant Work Experience:   
2 years call center and/or customer service experience in resolving billing and claims issues.
Prior Member or Customer Service experience preferred.

Knowledge, Skills & Abilities:
Able to answer and resolve a high volume of member and provider calls effectively.
Working knowledge of medical billing codes ICD9 / ICD10 and CPT coding a plus.
Bilingual: Korean, Farsi, Vietnamese, Cantonese, and/or Spanish language skills a plus.

To Apply:

Click below on “Apply for this Position” to create a profile and apply for the position. 

Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled