Job Description

Member Services Specialist

Location: Santa Barbara, CA (Hybrid)

Compensation: $50,000–$65,000 base + full benefits

About the Organization:

Our client is a mission-driven healthcare organization committed to improving access and quality of care for underserved populations across the Central Coast. With a strong culture of service, collaboration, and innovation, they deliver compassionate support and reliable health plan services for their members and provider partners.

The Opportunity:

The Member Services Specialist will serve as the first point of contact for health plan members, providing proactive, high-quality support via phone and other communication channels. This role is essential in helping members understand their benefits, navigate the healthcare system, and access necessary services. It's a great fit for someone who enjoys making a daily impact, thrives in a fast-paced environment, and brings empathy and efficiency to every interaction.

Key Responsibilities:

• Deliver robust customer service in a high-volume call center, addressing questions related to Medicare, Medi-Cal, supplemental benefits, referrals, claims, providers, and more
• Educate members on plan benefits, co-pays, provider networks, and health resources
• Assist with scheduling, interpreter coordination, and navigation of health-related documents
• Conduct outbound outreach such as new member orientation and coverage restoration support
• Serve as a liaison between members and departments like Care Coordination, Pharmacy, and Quality Management
• Triage continuity of care requests and coordinate with external agencies and community partners
• Handle grievance and appeal intake, and document all contact and follow-up activity
• Support compliance and quality initiatives as needed

What We're Looking For:

• 1–3 years of experience in healthcare customer service, preferably in a Medicare Advantage or Medi-Cal/D-SNP environment
• Knowledge of healthcare systems and benefits navigation; prior use of systems such as QNXT, CalSAWS, MedHok a plus
• Bilingual in Spanish preferred.
• Clear communicator who can explain complex benefits and procedures in a compassionate and accessible way
• Strong organizational and time management skills; able to juggle multiple tasks with attention to detail
• Flexible and comfortable working rotating shifts between 8am–8pm, 7 days/week (standard 40-hour workweek)Comfortable collaborating across departments and taking initiative to ensure a positive member experience.

Traits That Thrive in This Role:

• Mission-driven and people-first
• Calm under pressure and solutions-oriented
• Detail-focused with strong follow-through
• Strong interpersonal instincts and a desire to help others
• Adaptable to changing needs, systems, and schedules

Additional Requirements:

• Must be able to travel to the office as needed (hybrid schedule)
• Must possess a valid driver’s license and maintain a clean driving record
• Must be able to sit at a computer for extended periods and work in a standard office environment

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