Community Hospital of the Monterey Peninsula

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Member Svcs Trainer Audit_Aspire Health

at Community Hospital of the Monterey Peninsula

Posted: 6/27/2019
Job Status: Full Time
Job Reference #: 3009
Keywords: compliance

Job Description

Monterey, CA

Full Time

Work Hours: M-F 8am-5pm


Member Services Trainer/Auditor - Aspire Health Plan


Purpose of Position


The Member Services Trainer/Auditor will support all functions of the call center, to include developing call center related training, maintaining call center resource documents, and performing ongoing performance and quality audits in order to assure consistent, timely, compliant and courteous response to member questions. The Member Services Trainer/Auditor will have extensive knowledge of the Company’s processes and procedures and is responsible for resolving complex issues, to include routing questions and complaints to the appropriate department for expedient resolution. In addition, this position supports internal departments in ensuring that members and provider issues are appropriately resolved.


  • Develop call center related training and maintain call center resource documents
  • Perform ongoing performance and quality audits in order to assure consistent, timely, compliant and courteous response to member questions
  • Audit call recordings against documented standards and flag compliance issues that may be identified and escalate appropriately to the relevant department
  • Respond to escalated inquiries from members, providers and delegated entities, providing superior product and benefit information
  • Process member transactions, including but not limited to PCP changes, demographic changes, and membership material requests
  • Collaborate with Customer Service, Enrollment, Claims, Health Services, Pharmacy, A&G and Sales to ensure that members and provider requests are appropriately resolved
  • Identify issues impacting customer services’ ability to adequately provide information or assistance to members
  • Meet individual and departmental standards
  • Adhere to all regulatory requirements relating to member confidentiality, documentation, quality, and inquiry response time
  • Other duties as assigned 

 Position Requirements

  • Minimum A.A. degree or equivalent practical experience in related or similar positions.
  • At least two years' experience in customer service/call center within the managed care, insurance, healthcare, or related call center environment
  • Strong comprehension skills
  • Ability to communicate effectively, including written and verbal communication skills
  • High level of attention to details in obtaining complete and accurate information
  • Problem resolution skills
  • Strong interpersonal and negotiation skills
  • Ability to key data accurately and rapidly
  • Basic knowledge of insurance terminology and medical coding, e.g. ICD and CPT
  • Ability to operate computer equipment and software programs necessary to fulfill position responsibilities
  • Working knowledge of Microsoft office products including Outlook, Word, and Excel
  • Ability to interact professionally with co-workers, providers, clients, brokers and management-level staff.
  • Excellent phone manner and ability to handle multiple phone lines.
  • Must be able to meet established deadlines 

About Aspire

Aspire Health Plan is a locally owned Medicare Advantage HMO that provides comprehensive medical coverage to seniors and other Medicare recipients in Monterey County. We’re proud to be a community-centered organization backed by Community Hospital of the Monterey Peninsula and Salinas Valley Memorial Hospital. Over 700 doctors, many other healthcare providers, and all four Monterey County hospitals are part of the Aspire Health Plan network. It’s the care you need from people you know.

Aspire Health is an equal opportunity employer.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!