Member Services Representative

Position Description

Identify, triage, and transition continuity of care issues; assist members with the selection of Primary Care Providers (PCPs); explain program benefits; and facilitate referrals to internal programs, Community Based Organizations, and other appropriate services. Assist members with authorizations and coordinate health care services among the Health Plan, network providers, Radiology Benefit Management (RBM), Specialty Pharmacy, Durable Medical Equipment (DME) vendors, and tertiary care facilities (e.g., UCLA and other Centers of Excellence) to ensure seamless continuity of care.

Resolve issues related to other health coverage, including researching and documenting coverage changes and notifying Recoveries and the Department of Social Services (DSS) as appropriate. Provide guidance and support for the member portal, including education on portal features, navigation assistance, and general account inquiries. Support the Call Center management team by responding to and assisting members with webbased inquiries.

• Identify, triage, and transition continuity of care issues; assist members with PCP selection; explain program benefits; facilitate referrals to internal programs, Community Based Organizations, and other appropriate services.
• Assist members with authorizations and coordinate health care services among the Health Plan, network providers, RBM, Specialty Pharmacy, DME vendors, and tertiary care facilities to ensure seamless continuity of care.
• Resolve issues related to other health coverage, including researching and documenting coverage changes and notifying Recoveries and the Department of Social Services as appropriate.
• Provide guidance and support for the member portal, including education on portal features, navigation assistance, and general account inquiries.
• Support the Call Center management team by responding to and assisting members with webbased inquiries.

• Microsoft Office
• Customer Service
• Medi Cal
• Medical Terminology
• Call Center Operations
• Patient Services
• Prior Authorization
• Eligibility Verification

• Microsoft Office
• Customer Service
• Medi Cal
• Medical Terminology
• Call Center Experience

Candidates must be able to navigate and understand the following systems and screens:

• Eligibility (including all nine sub screens)
• MEDSLite and CalSAWS
• Adjudication
• Member Grievance - COG
• HIS Call Tracking System
• Provider Systems
• Cisco Agent Desktop
• RBM
• Authorization Processing (TAR)
• Claims Search
• Problem Claims Review
• Standard Reporting
• Procedures

• Entry Level

This is a Contract position based out of Santa Barbara, CA.

The pay range for this position is $26.00 - $26.00/hr eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:

• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

This is a hybrid position in Santa Barbara, CA.

This position is anticipated to close on Feb 20, 2026.

We re partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change.

That s the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

We re a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We re a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed.

We re strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We re building…