Apply on Employer Site

CalOptima · 4 days ago

Customer Service Representative Sr (General)

Orange, CA

Full-time

Hybrid

Mid, Senior Level

$50K/yr - $70K/yr

2+ years exp

CalOptima is a mission-driven community-based organization focused on serving member health with excellence and dignity. They are seeking a Customer Service Representative Sr (General) to be a senior point of contact for health members and providers, assisting with questions and complaints related to Medi-Cal programs and providing information on eligibility, enrollment, and benefits.

GovernmentHealth CareNon Profit

Comp. & Benefits

Responsibilities

Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability

Serves as a senior resource for other team members (i.e., solves complex challenges, answers uncommon questions and shares complex processes and procedures)

Handles and resolves escalated issues (i.e., customer service representative unable to handle/resolve)

Enters accurate and complete documentation into internal application systems regarding all concerns and/or inquiries from the member and provider interaction

Follows through on and completes all member and provider inquiries or requests during the original member and provider interaction. Provides additional follow-up assistance as needed

Identifies and communicates challenges that might arise with the use of professional judgment while adhering to departmental policies and procedures

Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department

Addresses member and provider inquiries, questions and concerns in all areas, including eligibility, enrollment, claims or authorization status, benefit interpretation and referrals/authorizations for medical care in-person or telephonically

Communicates, builds and maintains internal and external relationships by prompt and accurate service delivery

Maintains departmental productivity and quality standards

Completes other projects and duties as assigned

Qualification

Customer service experienceCall center experienceMedi-Cal/Medicaid experienceTyping speed 35 WPMMicrosoft Office proficiencyProblem-solving skillsCommunication skillsOrganizational skillsProject management skillsWork independently

Required

High School diploma or equivalent PLUS 2 years of experience in customer/member service, including 1 year call center capacity required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying

Typing speed of 35 words per minute (WPM) is required

Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds

Work independently and exercise sound judgment

Communicate clearly and concisely, both orally and in writing

Work a flexible schedule; available to participate in evening and weekend events

Organize, be analytical, problem-solve and possess project management skills

Work in a fast-paced environment and in an efficient manner

Manage multiple projects and identify opportunities for internal and external collaboration

Motivate and lead multi-program teams and external committees/coalitions

Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment

Ability to visually read information from computer screens, forms and other printed materials and information

Ability to speak (enunciate) clearly in conversation and general communication

Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions

Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting

Lifting and moving objects, patients and/or equipment 10 to 25 pounds