Customer Service Representative

2 weeks ago

Orange, California, United States Infojini Full time
Job DescriptionJob Description

Customer Service Representative (Non-Bilingual)
6+ months
Orange, CA

Duties & Responsibilities:

  • 80% - Program Support
  • Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
  • Maintains departmental productivity and quality standards.
  • Follows through on and completes all member and provider inquiries or requests during the original member and provider interaction.
  • Serves as a resource for other team members.
  • 15% - Administrative Support
  • 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.
  • Enters accurate and complete documentation into internal application systems regarding all concerns and/or inquiries from the member and provider interaction.
  • Communicates, builds and maintains internal and external relationships by prompt and accurate service delivery.
  • Identifies and communicates challenges that might arise with the use of professional judgment while adhering to departmental policies and procedures.
  • 5% - Completes other projects and duties as assigned.

Minimum Qualifications:

  • High School diploma or equivalent required.
  • 6 months of experience in a call center capacity required.
  • Typing speed of 35 words per minute (WPM) 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.

Preferred Qualifications:

  • 6 months of Medi-Cal/Medicaid or health services experience.

Knowledge & Abilities:

  • 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.

Physical Requirements (With or Without Accommodations):

  • 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

Work Environment:
If located at the 500, 505 Building or a remote work location:

  • Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
  • Employee will occasionally work outdoors in varied temperatures.
  • There may be harmful or hazardous environmental conditions present for this job.
  • The noise level in this work environment is usually moderate to loud.

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