Customer Service Rep, Sr.

2 weeks ago

Orange, United States Impresiv Health Full time
Title: Customer Service Rep, Sr. (Bilingual Required)

Duration: Temp - up to 6 months

Compensation: $23.92 - $33.49

Description: The Customer Service Representative Sr will serve as a senior point of contact for health plan's members and providers and will assist them with questions and/or complaints related to health plan services. The incumbent resolves member inquiries and complaints fairly and effectively. The incumbent provides information regarding eligibility, enrollment, benefits and services to Health Plans eligible members and providers.

What You Will Do:
  • Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
  • 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 inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care.
  • Serves as a senior resource for other team members (i.e., solves complex challenges, answers uncommon questions and shares complex processes and procedures).
  • Verifies member eligibility, claim and authorization status for providers.
  • Supports in the coordination of member's health care and social service needs both within and outside the medical group and health plan.
  • Enters accurate and complete documentation into internal application systems regarding all concerns and/or inquiries from the member and provider interaction.
  • Initiates referrals to both internal and external care management departments and other department/government or community agencies.
  • 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.
  • Provides additional follow-up assistance as needed.
  • Competes other projects and duties as assigned.

You Will Be Successful If:
  • Develop rapport and establish and maintain effective working relationships with 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.

What You Will Bring:
  • High School diploma or equivalent required.
  • 2+ years of experience in a customer/member service, including 1 year call center capacity required.
  • Typing speed of 35 words per minute (WPM) required.
  • Bilingual in English and in one of defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese) required.
  • 1 year of Health Maintenance Organization, Medi-Cal/Medicaid experience preferred.

About Impresiv Health:

Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.

Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do - provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.

That's Impresiv

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