Customer Service Representative Sr

4 days ago

Fremont, California, United States Info Way Solutions Full time
Job Summary

The Customer Service Representative Sr is the primary point of contact for CalOptima Health members and providers, providing assistance with questions related to Medi-Cal programs for Orange County.

The incumbent resolves member inquiries and complaints fairly and effectively, providing information regarding eligibility, enrollment, benefits, and services to CalOptima Health eligible members and providers.

Key Responsibilities
  • Participate in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity, and accountability.
  • Assist the team in carrying out department responsibilities and collaborate with others to support short- and long-term goals/priorities for the department.
  • Address member inquiries, questions, and concerns in all areas, including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care.
  • Verify member eligibility, claim, and authorization status for providers.
  • Responsible for thorough follow-up and completion of all member and provider inquiries or requests.
  • Responsible for accurate, complete, and correct documentation into Facets regarding all issues, inquiries, complaints, and grievances.
  • Function efficiently and productively in a high-volume call center.
  • Maintain departmental productivity and quality standards.
  • Provide follow-up assistance as needed.
  • Route escalated calls to the appropriate Member Liaison Specialist, Supervisor, or Call Center Manager.
  • Adhere to departmental policies and procedures.
  • Process all member transportation requests within one business day of receipt and coordinate all aspects of the process with the clinic, provider, and member as appropriate or necessary.
  • Assist members with CalOptima's Member Web Portal registration and technical support.
  • Interact face-to-face with members by assisting with front desk coverage.
  • Serve as a backup for Customer Service Leads, as needed.
  • Handle and resolve escalated issues.
  • Complete other projects and duties as assigned.
Requirements
  • High School diploma or equivalent required.
  • 2 years of experience in a customer/member service or call center capacity required.
  • An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position is also qualifying.
  • Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese) required.
Preferred Qualifications
  • 2 years of Health Maintenance Organization (HMO), Medi-Cal/Medicaid, and health services experience preferred.
Knowledge and Skills
  • Principles and practices of managed healthcare, healthcare systems, and medical terminology.
  • Principles and techniques for handling customer service issues.
  • Personal computers, keyboarding, and appropriate software to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
  • Customer service principles and practices.

Language: English

  • Customer Service Representative

    3 weeks ago

    Fremont, California, United States Pilot Freight Service Full time

    Job Title: Customer Service 1Job Summary:Pilot Freight Service is seeking a Customer Service 1 Agent to work out of our Fremont Station, located in Fremont, CA. The hours for this position will vary. Must be available to work weekends.Responsibilities:Assist the management team with opening and closing functions, including route assignment, confirming...

  • Customer Service Representative

    1 month ago

    Fremont, California, United States Info Way Solutions Full time

    Job SummaryWe are seeking a highly skilled Customer Service Representative to join our team at Info Way Solutions. As a key member of our customer-facing team, you will be responsible for delivering exceptional customer service through fast and accurate processing of orders, communication, and coordination with other departments to resolve inquiries.Key...

  • Customer Service Representative

    3 days ago

    Fremont, California, United States Apex Talent Solutions LLC Full time

    Customer Service RepresentativeWe are seeking a highly skilled and customer-focused Customer Service Representative to join our team at Apex Talent Solutions LLC.Key Responsibilities:Provide exceptional customer service through various communication channels, including phone, email, and chat.Respond to customer inquiries in a timely and professional manner,...

  • Customer Service Representative

    4 weeks ago

    Fremont, California, United States Qonten Full time

    Job Title: Call Center Customer Service RepresentativeWe are seeking a highly skilled and professional Call Center Customer Service Representative to join our team at Qonten. As a key member of our customer service team, you will be responsible for providing exceptional service to our clients, resolving customer complaints, and maintaining a positive and...

  • Customer Service Representative

    3 days ago

    Fremont, California, United States Info Way Solutions Full time

    Job Title: Customer Service RepresentativeAt Info Way Solutions, we are seeking a highly skilled and customer-focused Customer Service Representative to join our team. As a key member of our customer service team, you will be responsible for providing exceptional service to our customers via phone and email.Key Responsibilities:Respond to customer inquiries...

  • Customer Service Representative

    4 weeks ago

    Fremont, California, United States Ninna Chugh - State Farm Agent Full time

    {"h1": "Customer Relations Representative", "p": "At Ninna Chugh - State Farm Agent, we are seeking a skilled and empathetic professional to join our team as a Customer Relations Representative. As a customer-oriented expert, you will market the best Life/Health insurance services and products to benefit clients and their families. Your sales experience will...

  • Customer Service Representative

    3 days ago

    Fremont, California, United States Info Way Solutions Full time

    Job SummaryCalOptima Health is seeking a highly motivated and experienced Customer Service Representative to join our team. The Customer Service Representative will be the first point of contact for CalOptima Health's members and providers, assisting with questions and/or complaints related to the Medi-Cal programs for Orange County.Key...

  • Customer Service Representative

    3 days ago

    Fremont, California, United States Ultimate Staffing Full time

    Customer Service Representative/Inside Sales OpportunityWe are seeking a highly skilled Customer Service Representative/Inside Sales professional to join our team in Fremont. As a key member of our sales team, you will be responsible for providing exceptional customer service and support to our clients.Key Responsibilities:Interact effectively with customers...

  • Customer Service Representative

    7 days ago

    Fremont, California, United States Community Choice Financial Family of Brands Full time

    Job Title: Customer Service RepresentativeWe are seeking a highly skilled and customer-focused Customer Service Representative to join our team at California Check Cashing Stores. As a key member of our team, you will play a vital role in providing exceptional customer service and ensuring seamless transactions in our fast-paced...

  • Customer Service Representative

    4 weeks ago

    Fremont, California, United States Culligangreatlakes Full time

    Customer Service RepresentativeJob SummaryCulligan Great Lakes is seeking a highly skilled Customer Service Representative to join our team. As a key member of our office support team, you will be responsible for providing exceptional customer service, resolving product and service-related issues, and ensuring complete customer...

  • Domino's Customer Service Representative

    3 days ago

    Fremont, California, United States Domino's Franchise Full time

    Customer Service RepresentativeAs a Customer Service Representative at Domino's, you are the face of our brand. You will be the first point of contact for our customers, providing a fun, happy, and exciting environment while taking orders.Key Responsibilities:Provide exceptional customer serviceTake orders accurately and efficientlyUphold and represent the...

  • Domino's Customer Service Representative

    3 weeks ago

    Fremont, California, United States Domino's Franchise Full time

    Customer Service RepresentativeAs a Customer Service Representative at Domino's, you are the face of our brand. Your interactions with customers play a crucial role in creating a positive experience for them. You will be responsible for providing exceptional customer service, taking orders, and upholding the Domino's brand image.Key Responsibilities:Provide...

  • Bilingual Customer Service Representative

    4 days ago

    Fremont, California, United States TMS Services Full time

    Customer Service Representative OpportunityWe are seeking a highly skilled and multilingual Customer Service Representative to join our team at TMS Services. Our company is based in the San Jose area and provides advanced growth opportunities for our employees. We assist local businesses with new internet and wireless solutions on a day-to-day basis.Our...

  • Customer Service Representative

    2 weeks ago

    Fremont, California, United States Info Way Solutions Full time

    Job SummaryWe are seeking a highly skilled Customer Service/Order Entry professional to join our team at Info Way Solutions. As a key member of our customer-facing team, you will be responsible for delivering exceptional customer service and ensuring the timely and accurate processing of orders.Key ResponsibilitiesProvide fast and accurate processing of...

  • Customer Service Representative

    2 weeks ago

    Fremont, California, United States LaborMax Staffing Full time

    Job SummaryWe are seeking a highly skilled and motivated Customer Service Representative to join our team at LaborMax Staffing. As a key member of our sales and service team, you will be responsible for providing exceptional customer service, processing orders, and maintaining accurate records.Key ResponsibilitiesProvide clear and concise product information...

  • Customer Service Representative

    4 days ago

    Fremont, California, United States Premier Subaru of Fremont Full time

    About UsPremier Subaru of Fremont is part of a successful Premier Automotive Group with over 32 stores in 7 states nationwide. We represent top brands such as Honda, Toyota, Nissan, Kia, Dodge, Chrysler, Jeep, and Fiat.Job SummaryWe are seeking a Cashier/Customer Service Representative, Part-Time to join our team. As a key member of our team, you will be...

  • Domino's Customer Service Representative

    4 days ago

    Fremont, California, United States Domino's Franchise Full time

    Customer Service RepresentativeAs a Customer Service Representative at Domino's, you are the face of our brand. Your interactions with customers play a crucial role in creating a positive experience for them. You will be responsible for providing excellent customer service, taking orders, and ensuring that our customers receive their orders in a timely...

  • Customer Service Representative

    4 weeks ago

    Fremont, California, United States The Oilgear Company Full time

    Job SummaryWe are seeking a highly skilled Customer Service Representative to join our team at The Oilgear Company. As a key member of our Operations Support team, you will be responsible for providing exceptional customer service and support to our clients.Key ResponsibilitiesRespond to customer inquiries and resolve issues in a timely and professional...

  • Customer Service Representative

    1 month ago

    Fremont, California, United States Wayne Overhead Door Sales and Home Improvements Full time

    Job SummaryWe are seeking a highly skilled and detail-oriented Customer Service Representative to join our team at Wayne Overhead Door Sales and Home Improvements. As a key member of our staff, you will be responsible for providing exceptional customer service, managing office functions, and contributing to marketing campaigns.Key ResponsibilitiesCustomer...

  • Customer Service Representative

    5 hours ago

    Fremont, California, United States Ninna Chugh - State Farm Agent Full time

    Job DescriptionAt Ninna Chugh - State Farm Agent, we are seeking a highly skilled and empathetic professional to fill the role of Customer Relations Representative. As a customer-oriented expert, you will be responsible for marketing the best Life/Health insurance services and products to benefit clients and their families. Your sales experience will equip...