Member Services Representative-90106

Job Locations US-OR-Hillsboro
Tuality Health Alliance-90109
Req #
Job Type
Full Time (80 hours per pay period)
# of Openings
Budgeted Hours Per Pay Period

Summary of Duties

Provides customer related services to OHP & commercial enrollees and physicians; including answering THA phone lines and responding to plan related inquiries.  Must be able to explain health plan benefits, health plan requirements, policies and procedures, and payment determinations as appropriate.  Responsible for aiding newly enrolled individuals to assist with information and accessing health care services with Tuality Health Alliance.  Provide reminder and other outreach phone calls to members to encourage compliance in keeping and making appointments with their PCP to obtain healthy outcomes.

Assists with assigning primary care providers and maintaining compliance.  Handles the coordination of all printed materials ensuring they are accurate and that adequate stock is maintained. Responsible for member mailings to new and existing members within appropriate timelines.  Provides customer-related support services for Quality Improvement, Medical Management, Claims and Contracting functions.  Maintains non-par physician data base in Plexis Claims Management system.

Hiring Competencies

a)    Education: Associate degree or minimum one-year medical/health insurance or related experience.

b)    Fluency in Spanish preferred.

c)    License: None required.

d)    Working knowledge of medical terminology, ICD-10 and CPT codes.

e)    Experience working in highly confidential settings.

f)     Possesses excellent telephone skills and interpersonal communication.

g)    Knowledge of health plans guidelines and policies.

h)    Organization and prioritization abilities. Clear and concise communication skills including verbal & written.

i)     Effective problem-solving skills.

j)     Proficiency in operating personal computer, specifically in a Microsoft Office environment.

k)    Ability to follow instructions.

l)     Detail oriented with excellent organizational skills.

m)   Capability in dealing with multiple demands in a fast-paced office in a calm and professional manner.

n)    Knowledge of billing and referral procedures.

o)    Ability to handle crisis situations with members and providers and bring to resolution.

p)    Flexible and team oriented.


At Tuality Healthcare, an OHSU Partner, it's an honor and a privilege to serve those near us. That's why since our beginnings in 1918, and as we expand our strong network of services through our clinical affiliation with OHSU, we continue to be committed to providing the best health care possible and a valued community partner.  Our affiliation with OHSU brings the advanced medical resources of Oregon’s only academic health center, which allows local providers to receive guidance from some of the country’s top specialists and pass that expertise on to Tuality patients where they can be cared for in their community. 


Tuality’s many awards showcase our position as one of the Portland metro area’s premier healthcare providers, including 5th straight year in Top 10 Healthiest Employers in Oregon from The Portland Business Journal, Tuality’s 6th straight Gold Plus Award from the American Heart Association, and 2016 #1 Nationwide Best Hospital IT Department to work for according to Healthcare IT News.


Here at Tuality our employees care about making a difference.  In fact, they care so much that in our most recent employee satisfaction survey we had an 80% participation rate!  Tuality is truly unique because of the relationships we build and as individuals we are seen and heard.  Come be part of our team, and let your voice be heard!

Additional Posting Information

Tuality Healthcare believes in providing equal employment opportunities for all qualified individuals. Recruitment, hiring, promotions, transfers, working conditions, training, and compensation will be based on qualifications without regard to race, color, sex, sexual orientation, gender identity, religion, age, creed, national origin, marital status, family relationship, veteran status, genetic information, physical or mental disability, or any other status or characteristic protected by applicable law. We further commit ourselves to continuing the practical application of this policy in our daily business conduct.


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