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Member Data Coordinator

San Francisco Health Plan

San Francisco Health Plan

San Francisco, CA, USA
Posted on Friday, November 10, 2023

You can make a difference in the San Francisco communities. We are looking for a full-time Member Data Coordinator.

Reporting to the Manager of Member Data, the Member Data Coordinator is responsible for the accuracy of health plan member data pertaining to eligibility, PCP assignments, coordination of benefits, and other related member coverage. Responsibilities include correcting member eligibility in QNXT, resolving eligibility problems for providers/vendor groups, assigning PCP for members, identifying other health coverage of members by making outreach calls, and achieving organizational and departmental goals.

Schedule: Monday - Friday, 8:30 AM -5:30 PM


  • Manually reconcile and correct eligibility discrepancies within the required time frame.
  • Handle eligibility discrepancy issues for vendor groups and network providers and find resolutions.
  • Manually assign and reassign a PCP to member and maintains member attributes to keep track of most updated member records.
  • Manually correct and update the eligibility for Healthy Workers HMO members and City Workers members including its Cobra coverage.
  • Find information of member's other health coverage and Third-Party Liability and report them to DHCS in 10 calendar days. Follow up until eligibility is changed.
  • Contact Medi-Cal to correct information listed in MC website.
  • Manage COB information for members with dual coverage.
  • Work with other health coverage vendors to update Claims Operating System on member's eligibility and coordinate benefits.


  • High school graduate or GED. Bachelor's degree which can be substituted by two years of work experience related to member eligibility.
  • Experience in member eligibility information and verification
  • Knowledge of Claims Operating System especially with the Member Module a plus.
  • Experience in a call center environment and ACD system a plus.
  • Demonstrate familiarity and understanding of California managed care and medical terminology. Understanding of and ability to process confidential information and personal health information with competence, care and discretion.
  • Experience using Excel for reporting and data entry


  • Medical Plans: You’ll have a choice of medical plans, including options from Kaiser and Blue Shield of California. Employee-only coverage in the the HMO plans is currently available at no cost and dependent coverage is heavily subsidized by SFHP.
  • Dental: You’ll have a choice of a basic dental plan or an enhanced dental plan which includes orthodontic coverage.
  • Vision: Employee vision care coverage is available at no cost.
  • Time Off: 23 days of Paid Time Off and 12 observed company holidays.
  • Professional development: Opportunities for tuition reimbursement, professional license/membership.


Established in 1994, San Francisco Health Plan (SFHP) is an award winning, managed care health plan whose mission is to provide affordable health care coverage to the underserved low and moderate-income residents in San Francisco County. SFHP is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 170,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services. SFHP was designed by and for the residents it serves, and takes great pride in its ability to accommodate a diverse population that includes young adults, seniors, and people with disabilities.

San Francisco Health Plan is proud to be an equal opportunity employer. We are committed to a work environment that supports, inspires, and respects all individuals and in which our people processes are applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristics.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

San Francisco Health Plan is an E-Verify participating employer.

Hiring priority will be given to candidates residing in the San Francisco Bay Area and California.