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Health Plan of San Joaquin/Mountain Valley Health Plan · 1 day ago

Customer Service Representative

French Camp, CA

Full-time

Onsite

New Grad, Entry Level

$43K/yr - $52K/yr

Health Plan of San Joaquin/Mountain Valley Health Plan is seeking a Customer Service Representative to join their team. The role involves responding to and resolving inquiries from customers in a call center environment, while providing information on benefits, eligibility, and claims.

Health CareHealth InsuranceInsurance

Responsibilities

Provides information on benefits, eligibility, claims, authorizations and other related items over the phone and in person

Researches and resolves issues related to claims and authorizations; monitors progress

Researches and resolves complex eligibility issues; monitors progress

Creates required documentation, including but not limited to call logs and other tracking systems

Qualification

Customer Service ExperienceMedi-CalMedicare DSNPManaged careBasic knowledge of contact center systemsBasic skills in WindowsBasic skills in WordBasic skills in ExcelBasic skills in OutlookBasic conflict resolutionListening skillsHandle confidential informationType 40 WPMSpeak EnglishInterpersonal skillsOral communicationWritten communicationWork independentlyWork in a team

Required

Produces work that is accurate and complete

Actively learns through experimentation when tackling new problems, using both successes and failures to learn

Rebounds from setbacks and adversity when facing difficult situations

Knows the most effective and efficient process to get things done, with a focus on continuous improvement

Interpersonal skills - interacts effectively with individuals both inside and outside of HPSJ; relates openly and comfortably with diverse groups of people

Strong oral and written communication skills, with ability to express self clearly and professionally, and document according to standards

Strong listening skills, with the ability to accurately receive and understand messages

Basic conflict resolution skills, with the ability to use tact and diplomacy to diffuse emotional situations

Ability to work independently and as part of a team

Demonstrates a commitment to HPSJ's strategy, vision, mission and values

Ability to read, understand and apply complex written guidelines, instructions and other materials

Ability to compare and discern the difference between multiple sets of data or information

Basic arithmetic skills

Basic knowledge of contact center systems

Basic skills in Windows, Word, Excel and Outlook

Ability to navigate multiple systems and resources simultaneously

Ability to handle confidential information with appropriate discretion

Ability to speak and be understood in English

Proficiency (as defined by HPSJ's Cultural and Linguistics Program) in one of HPSJ's threshold languages may be required, depending on business requirements

Must type 40 WPM

Must pass Call Center Listening Skill test with a score of 71+

High school diploma or general education degree

Customer Service experience

Preferred

Ability to efficiently and effectively handle calls of heavy volume (50-100 per day), including documentation and resolution

Knowledge of Medi-Cal programs

Knowledge of Medicare DSNP programs

Knowledge of managed care

Knowledge of medical policy benefits and exclusions

Knowledge of medical terminology

Knowledge of ICD and CPT coding

Associate's Degree

Experience in customer service in a health plan, managed care, Medicare DSNP and/or Medi-Cal

At least one year handling heavy call volume (50-100 calls per day)

Benefits

Competitive salary

Robust and affordable health/dental/vision with choices in providers

Generous paid time off (accrue up to 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays)

CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution plan

Two flexible spending accounts (FSAs)

Employer-Paid Term Life and AD&D Insurance

Employer-Paid Disability Insurance

Employer-Paid Life Assistance Program

Health Advocacy

Supplemental medical, legal, identity theft protection

Access to exclusive discount mall

Education and training reimbursement in addition to employer-paid elective learning courses.

A chance to work for an organization that is mission-driven – our members and community are at the core of everything we do.

A shorter commute – if you’re commuting from the Central Valley to the Bay Area.

Visibility and variety – you have a chance to work with people at all levels of the organization, and work on diverse projects.

Company

Health Plan of San Joaquin/Mountain Valley Health Plan

Health Plan of San Joaquin/Mountain Valley Health Plan (not-for-profit health plan) is the leading Medi-Cal managed care provider in San Joaquin in Stanislaus Counties, now serving Medi-Cal members in Alpine in El Dorado Counties.

Founded in 1996