Jobs
>
San Francisco

    Health Plan Representative - San Francisco, United States - Kaiser Permanente

    Kaiser Permanente
    Kaiser Permanente San Francisco, United States

    2 weeks ago

    Kaiser Permanente background
    Description
    Job Summary:

    Position(s) located within the local area Member Services Department reporting to Member Services Operations Director. Educates providers, staff and members on Health Plan benefits and services. Responsible for intake and resolution of complaint and grievance cases within the Medical Center and medical offices. Responsible for partnering with internal and external staff and departments to provide creative, timely solutions for member concerns. Assist in development of new programs / service improvements for members, providers and facility personnel. Assists with training, audits and other activities as necessary. This position helps drive the mission and business results for Kaiser Permanente.

    Essential Responsibilities:
    • Act as liaison between the patient/member and Kaiser Permanente in providing general assistance and education on how to utilize multiple Kaiser system, resolve member complaints and grievances as efficiently as possible, and answer Health-Plan related questions.
    • Partner with other departments in the organization, such as Marketing and Health Education, and attends community, employer and KP events to ensure accurate information is provided to various clientele regarding KP services, benefits, and protocols.
    • Research, resolve and communicate Health Plan/coverage/benefit-related issues for members.
    • Maintain current comprehensive knowledge of Health Plan benefits, eligibility and exclusions.
    • Educate providers, staff and individual members on Health Plan benefits and services, explaining the details of specific member plans.
    • Participate in research or resolution of the organizations complaint and grievance process.
    • Responsible for communicationg with members or their authorized representatives(s), regarding the Health Plans communicationa dn grievance/complaint process.
    • Appropriately interview member/patient (or authorized representative of patient) in person or via phone regarding benefit, service, and medical care issues, document, and triage all case information to correspondence center. Accountable for investigation of issues, including collection and documentation of appropriate data.
    • Effectively handle and attempt to resolve member issues that are received from numerous sources.
    • Appropriately transfer all applicable cases and accompanying documentation after initial resolution effort in keeping with all regulatory requirements and internal policies and procedures.
    • Assist non-English or limited-English speaking customers in the use of interpreter services.
    • Responsible for communicating with members or their authorized representative(s), regarding the Health Plans response and grievance/ complaint process.
    • Ensure that complaints and grievances are processed in accordance with regulations, compliance standards, policies and procedures. Regulators include, but are not limited to: Center for Medicare/Medicaid (CMS), California Department of Managed Healthcare (DMHC), Department of Health Services (DHS), Department of Labor, Department of Consumer Affairs, the National Committee for Quality Assurance (NCQA).
    • Ensure integrity of departmental database by thorough, timely and accurate entry, consistent with regulatory protocols and applicable P&Ps and effectively manages case resolution inbox everyday.
    • Research and resolve, to the extent possible, member/system conflicts to obtain member satisfaction and minimize health plan risks.
    • Interpret and communicate Health Plan benefits/contracts to internal and external clients.
    • Responsible for the written and verbal interpretation of the Health Plan service agreement. Educate members/patients about their rights and responsibilities, medical center services, policies and procedures.
    • Identifies member - system conflict in an effort to prevent professional liability, minimize financial penalties to the organization, and retain satisfied members.
    • Communicate continually with a diverse set of internal and external clientele to achieve excellent results in the areas of complaint and grievance handling, compliance, documentation, benefit/contractual information, and enhancement of the member experience.
    • Collaborate with internal staff, managers and physicians, to identify opportunities to advocate for the member and resolve issues as quickly as possible.
    • Usiing conflict resolution and mediation skills, secure action from multiple stakeholders.

    Grade 303

  • Kaiser Permanente

    Health Plan Representative

    1 week ago

    Kaiser Permanente San Francisco, United States

    **Job Summary**: · Position(s) located within the local area Member Services Department reporting to Member Services Operations Director. Educates providers, staff and members on Health Plan benefits and services. Responsible for intake and resolution of complaint and grievance c ...

  • Kaiser Permanente

    Health Plan Representative

    1 week ago

    Kaiser Permanente San Francisco, United States

    Job Summary: · Position(s) located within the local area Member Services Department reporting to Member Services Operations Director. Educates providers, staff and members on Health Plan benefits and services. Responsible for intake and resolution of complaint and grievance cases ...

  • Kaiser Permanente

    Health Plan Representative

    2 weeks ago

    Kaiser Permanente San Francisco, United States

    : Job Summary: · Position(s) located within the local area Member Services Department reporting to Member Services Operations Director. Educates providers, staff and members on Health Plan benefits and services. Responsible for intake and resolution of complaint and grievance ca ...

  • Kaiser Permanente

    Health Plan Representative

    1 day ago

    Kaiser Permanente San Francisco, United States

    Job Summary: · Position(s) located within the local area Member Services Department reporting to Member Services Operations Director. Educates providers, staff and members on Health Plan benefits and services. Responsible for intake and resolution of complaint and grievance case ...

  • ENGEO

    Construction Field Representative

    1 week ago

    ENGEO San Francisco, United States

    : · ENGEO is actively looking for a Soil Technician/Field Representative, who is also interested in cross-training in Special Inspections. · **Position Summary**: As an ENGEO FR, you will represent ENGEO on various job sites, delivering the highest quality client service. Our Soi ...

  • Harbor Interfaith Services

    Director of The Coordinated Entry System

    3 weeks ago

    Harbor Interfaith Services San Pedro, United States

    HARBOR INTERFAITH SERVICES · Director - Coordinated Entry System (CES) · (Families, Single Adults & Youth) · SUMMARY OF RESPONSIBILITIES The Director - CES is responsible for on-going administration and oversight of Family, Single Adult & Youth CES in Service Planning Area 8 (SPA ...

  • City and County of San Francisco

    Chief Building Inspector

    1 week ago

    City and County of San Francisco San Francisco, United States

    **Company Description** THIS IS A CITYWIDE EXAM** · Application Opening: April 22, 2024 · Application Deadline: May 12, 2024 · Recruitment ID: CBT-6334-X00068 · San Francisco is a vibrant and dynamic city, on the forefront of economic growth & innovation, urban development, arts ...

  • T-Mobile (MobileOne, LLC)

    T-mobile - Retail Sales Representative - Geary San

    3 weeks ago

    T-Mobile (MobileOne, LLC) San Francisco, United States

    **Requirements**: · **In order to be a Retail Sales Representative, you need to have the following**: · - Customer service and/or sales experience preferred, Retail environment a plus. · - Authorization to work in the United States. · - Pass a pre-employment background check (wil ...

  • CCM Management

    Client Relations Coordinator

    1 week ago

    CCM Management San Francisco, United States

    Our firm is currently seeking an individual to join our team as an innovative, entry-level Client Relations Coordinator. We combine divergent skill sets and services to create integrated sales campaigns and compelling customer experiences. We know the importance of connecting bra ...

  • Grupo Degusplus

    Customer Service Representative

    3 weeks ago

    Grupo Degusplus San Francisco, United States

    Job Summary: · We are seeking a highly motivated and customer-oriented individual to join our team as a Customer Service Representative. As a Customer Service Representative, you will be responsible for providing exceptional service to our clients and ensuring their needs are met ...

  • WW International

    Chief of Staff, Legal

    2 weeks ago

    WW International San Francisco, United States

    What you will do: · Reporting directly to the General Counsel, the Chief of Staff role is a force multiplier for the Legal team. You will wear many hats, your core responsibility lies in the definition and execution of strategic projects and legal operations. You will ensure the ...

  • Green Spoon Sales

    Retail Merchandising Specialist

    2 weeks ago

    Green Spoon Sales San Francisco, United States

    Green Spoon Sales is an established natural food + beverage sales agency, representing the most exciting brands in CPG nationwide. We are a mission-driven team fueled by the desire to transform the retail landscape and bring healthier, cleaner, sustainable products to market. Joi ...

  • Amgen

    Biomarker Scientist

    1 week ago

    Amgen San Francisco, United States

    **HOW MIGHT YOU DEFY IMAGINATION?** · You've worked hard to become the professional you are today and are now ready to take the next step in your career. How will you put your skills, experience and passion to work toward your goals? At Amgen, our shared mission—to serve patients ...

  • Arcon Construction Corp.

    Project Managers

    1 week ago

    Arcon Construction Corp. San Francisco, United States

    We are hiring well organized and detail-oriented Construction Project Managers to join our growing team. In this position, you will oversee construction schedule, coordinate contractors, and manage the construction process. · **Responsibilities include**: · - Plan and oversee imp ...

  • Meta

    Product Marketing Manager, Product Compliance

    2 weeks ago

    Meta San Francisco, United States

    We believe in the endless power of people when they come together. But we also believe strongly in our responsibility to minimize harm and keep people safe. In this role, you will be responsible for helping to shape roadmaps and develop and execute against launch plans for the in ...

  • CRC

    Broker - Property

    3 weeks ago

    CRC San Francisco, United States

    Need Help?- Accessibility_ · - (accommodation requests only; other inquiries won't receive a response)._ · Regular or Temporary: · Regular · Language Fluency: English (required) · Work Shift: · 1st shift (United States of America) · Please review the following job description: · ...

  • Safe-Guard Products International LLC

    Business Development Representative

    1 week ago

    Safe-Guard Products International LLC San Francisco, United States

    **Job Title**:Business Developement Representative · - (This is an evergreen job posting)_ · **Location**: US- Remote · **FLSA**:Exempt · **Job Overview**: · The Business Development Representative supports a major OEM auto maker relationship, the OEM's retail dealerships, and re ...

  • Aspire Public Schools

    Technology Teacher

    1 week ago

    Aspire Public Schools San Francisco Bay Area, United States

    **GENERAL SUMMARY**: · The Technology Teacher will be responsible for providing a high quality instruction within a small school environment where every student is known and valued as an individual; uphold the mission and values of Aspire Public Schools and contribute to our goal ...

  • Atlassian

    Head of Global Incident and Escalation Management

    3 weeks ago

    Atlassian San Francisco, United States

    Overview: · **Working at Atlassian** · Atlassians can choose where they work - whether in an office, from home, or a combination of the two. That way, Atlassians have more control over supporting their family, personal goals, and other priorities. We can hire people in any countr ...

  • Kaiser

    Nursing Project Coordinator

    2 weeks ago

    Kaiser San Francisco, United States

    Job Summary: · Provides project management analysis, recommendations and decision support for a broad array of complex issues. Provides subject matter expertise to teams charted to address and develop recommendations for current/future operations. Promotes internal and external ...