Department(s): Customer Service
Reports to: Supervisor, Customer Service
FLSA status: Non-Exempt
Salary Grade: C – $41,000 – $53,000
Job Summary
The Customer Service Representative (CSR) is the first line of contact for CalOptima members and providers. The incumbent will assist members and providers with questions related to the Medi-Cal programs for Orange County. Resolves member inquiries and complaints fairly and effectively. This position will provide information regarding eligibility, enrollment, benefits and services to CalOptima eligible members and providers.
Position Responsibilities:
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.
Communicate, build, and maintain internal and external relationships by prompt and accurate service.
Carefully identify and communicate challenges that might arise with the use of professional judgement while adhering departmental policies and procedures.
Serves as a mediator to ensure interest of Members and CalOptima are protected.
Responsible for follow-up and completion of all member, and provider inquires or requests.
Responsible for accurate, complete, and correct documentation into Facets regarding all issues, and/or inquires, complaints and grievances.
Serves as a resource for other team members.
Function efficiently and productively in a high-volume telephone call center.
Maintain departmental productivity and quality standards.
Other projects and duties as assigned.
Knowledge & Abilities:
Establish and maintain effective interpersonal relationships.
Ability to work efficiently and productively in a high-volume call center environment.
Ability to work in a team.
Ability to multitask.
Basic understanding of managed health care, health care systems, and medical terminology.
Ability to apply principles and techniques for handling customer service challenges.
Communicate clearly and concisely, both verbally and in writing.
Excellent knowledge of customer resolution skills.
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.
Experience & Education:
High school diploma or equivalent required.
6+ months of customer service required.
Bilingual in English and in one of CalOptima’s defined threshold language (Spanish, Vietnamese, Arabic, Farsi, Korean, or Chinese) is required.
Preferred Qualifications:
Health Maintenance Organization (HMO), Medi-Cal/Medicaid and Health Services experience preferred.
3-6 months of call center experience preferred.
40 WPM preferred.
CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. You can request reasonable accommodations by contacting Human Resources Disability Management at 657-900-1134.
Job Location: Orange, California
Position Type:
To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/3320
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