L.A. Care Health Plan · 14 hours ago
Customer Solution Center Service Representative III
1200 Building
Full-time
Onsite
Entry, Mid Level
$55K/yr - $83K/yr
2+ years expL.A. Care Health Plan is the nation’s largest publicly operated health plan, dedicated to providing health coverage to low-income residents of Los Angeles County. The Customer Solution Center Service Representative III is responsible for handling provider inquiries, issue resolution, and providing support to members as part of the Customer Solution Center's mission to deliver quality service.
FitnessGovernmentHealth Care
Responsibilities
Assist providers in response to telephonic and electronic inquiries and concerns on all products and paid/unpaid claims. Ensure that accurate information is being given to the provider in a timely manner and with the highest level of customer service. Handle Level One (1) provider inquiries this includes (but not limited to): general inquiries on claims processing, payment status and appeal and eligibility status verification. Document the interaction with the provider, including any resolution or escalation steps in the system of record for each call. Provide detailed information for each call including: Caller information; Information related to request/issue; Resolution information or escalation steps. Escalate Level Two (2) provider concerns to the Claims Department for resolution (e.g. Provider Disputes, incorrectly paid claims, payment check status, and Explanation of Benefits (EOB) requests. (50%)
Applies subject expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that the facts and details are correct so that the project’s/program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed.(20%)
Support the Call Center in meeting State regulatory requirements by handling member-related inbound calls. (10%)
Perform special projects and ad-hoc assignments when necessary. (10%)
Perform other duties as assigned. (10%)
Qualification
Required
High School Diploma/or High School Equivalency Certificate
At least 2 years of experience in customer service in a high-call-volume healthcare customer service call center, including a minimum of 2 years of general claims inquiry or managed care specialty line of business experience
Customer service training in a healthcare environment
Data entry experience with the ability to type a professional minimum of 35 wpm
Working knowledge of Microsoft Office Suite (e.g. Word, Excel, PowerPoint, Outlook)
Excellent communication skills (written and verbal)
Ability to navigate multiple programs/databases while assisting each caller
Proficient knowledge in healthcare product lines, medical terminology and claims processes
Preferred
Technical training/certificate in a technical or business school (e.g. medical billing, medical terminology, medical coding, healthcare)
Benefits
Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)
Company
L.A. Care Health Plan
L.A. Care’s mission is to provide access to quality health care for L.A.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Melanie Rainer
Chief Strategy and Transformation Officer
Recent News
2026-01-17
MarketScreener
2025-08-27
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