REMOTE! CLIENT SERVICE REP
SGA Inc.
Member Services Agent
Software Guidance & Assistance, Inc., (SGA), is searching for a Member Services Agent for a Contract assignment with one of our premier Healthcare clients in Los Angeles CA. (100% remote PST hours)
The Member Services Agent serves as the primary point of contact for members and patients, providing exceptional customer service, education, and issue resolution. This role handles inbound calls, documents member interactions, assists with healthcare-related inquiries, and collaborates with internal departments to ensure timely and effective service.
Answer and manage inbound member and patient calls with professionalism, empathy, and excellent customer service.
Educate members regarding healthcare benefits, coverage, eligibility, referrals, authorizations, provider networks, claims, and member rights and responsibilities.
Facilitate warm transfers and coordinate with internal departments to ensure seamless service.
Serve as a liaison between members, patients, providers, and contracted health plans as needed.
Documentation & Administrative Support
Accurately document all member interactions, requests, updates, and resolutions in the managed care information system.
Utilize departmental resources, systems, and tools to support service delivery and productivity goals.
Adhere to call handling standards, customer service protocols, and approved communication scripts.
Compliance & Quality
Support departmental quality improvement initiatives and recommend process improvements when appropriate.
Monitor and contribute to achieving customer service, quality, and productivity metrics.
Uphold UCLA Health service standards, patient experience expectations, and workplace conduct policies.
High School Diploma, GED, or equivalent.
Minimum of 3 years of customer service, member services, or related experience in a healthcare environment.
The role requires documenting research, call outcomes, discrepancies, and next steps in a clear, organized, and audit-ready manner.
Proficiency with computer systems, Microsoft Office applications, and data entry.
Ability to work standard business hours (8:00 AM 5:00 PM PST) and occasional overtime when required.
Experience with EPIC Tapestry, CRM systems, or similar healthcare technology platforms.
Experience working in managed care, health plans, or healthcare customer service environments.
We are a women-owned business. Our mission: to solve big IT problems with a more personal, boutique approach. You'll join a diverse team built on these core values: customer service, employee development, and quality and integrity in everything we do.
- ...Job Description Job Description Job Summary: Responsible for managing a variety of member service calls in a professional and timely manner. Provide exceptional member service to members and internal staff at all times. Essential Duties and Responsibilities...SuggestedWork experience placementLocal area
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