Customer Service Representative

3 weeks ago

Orange, United States CalOptima Full time

**Customer Service Representative**

**CalOptima**

**CalOptima Health** is seeking a highly motivated an experienced **Customer Service Representative** to join our team. The Customer Service Representative (CSR) will be the first line of contact for CalOptima Health's members and providers. The incumbent will assist members and providers with questions and/or complaints related to the Medi-Cal programs for Orange County. The incumbent will provide information regarding eligibility, enrollment, benefits and services to CalOptima Health's eligible members and providers.

**Position Information**:

- Department**:Customer Service**:

- Salary Grade**:301 - $47,840 - $64,584 ($23.00 - $31.0500)**:

- Work Arrangement**:Full Office**

**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.
- 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.
- Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese)

**Required Licensure / Certifications**:

- N/A

**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.

**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:

- There are no harmful environmental conditions present for this job.
- The noise level in this work environment is usually moderate.

If located at PACE:

- Work is typically indoors in a clinical setting serving the frail and elderly.
- There may be harmful or hazardous environmental conditions present for this job.
- The noise level in this work environment is usually moderate to loud.

If located in the Community:

- 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.

**About CalOptima Health**:
CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals worki

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