Senior Customer Service Representative

3 weeks ago

Washington, Washington, D.C., United States El Paso Children's Hospital Full time

About the Role:

The Senior Customer Service Representative will serve as the senior point of contact for CalOptima Health members and providers, assisting them with questions and/or complaints related to the Medi-Cal programs for Orange County.

Responsibilities include:

  • Providing information regarding eligibility, enrollment, benefits, and services to CalOptima Health's eligible members and providers.
  • Participating in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity, and accountability.
  • Assisting the team in carrying out department responsibilities and collaborating with others to support short- and long-term goals/priorities for the department.
  • Serving as a senior resource for other team members, addressing 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.
  • Identifying and communicating challenges that might arise with the use of professional judgment while adhering to departmental policies and procedures.
  • Entering accurate and complete documentation into internal application systems regarding all concerns and/or inquiries from the member and provider interaction.
  • Maintaining departmental productivity and quality standards.
  • Completing other projects and duties as assigned.

Requirements include:

  • 2 years of experience in a customer/member service or call center capacity.
  • Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese).
  • 1 year of Medi-Cal/Medicaid or health services experience.
  • Typing speed of 35 words per minute (WPM).

About CalOptima Health:

CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives.

We prohibit 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.

Reasonable accommodations will be made for individuals with disabilities or disabled veterans. Please contact Human Resources Disability Management at least 72 hours in advance to request accommodations.

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