Customer Service Representative II
4 days ago
L.A. Care Health Plan is seeking a highly skilled Customer Solution Center Representative II to join our team. As a key member of our Customer Solution Center, you will be responsible for providing exceptional customer service to our members, providers, and advocates.
Key Responsibilities- Assist members with access to care issues, coordination of care issues, benefits, Evidence of Coverage (EOC), and Member Handbook.
- Handle and resolve member issues, assist members in connecting with internal units or external parties.
- Provide essential information to members regarding benefits, EOC, and Member Handbook.
- Assist providers in using the Interactive Voice Response (IVR) web portal and verifying member eligibility.
- Document all calls via the member database systems (QMEIS).
- Ensure department compliance with HIPAA regulations.
- Troubleshoot and direct calls to the appropriate departments or outside entities.
- Process payments for L.A. Care Covered members.
- Support robocall and ad-hoc member outreach activities as determined by business need.
- At least 1 year of customer service call center experience in a healthcare environment.
- Data entry experience with ability to type a minimum of 40 wpm.
- Ability to answer a high volume of calls; previous ACD experience preferred.
- Knowledge of medical terminology, good understanding of service to the disadvantaged population, seniors, and/or people with chronic conditions or disabilities.
- Must be a quick learner, excellent team player, and customer service oriented.
- Managed care or health plan experience.
- Bilingual in one of L.A. Care Health Plan's threshold languages is highly desirable.
L.A. Care Health Plan Call Center is available 24 hours a day, 7 days a week, including holidays. Call Center work shifts are assigned based on business need and may include evenings, weekends, and holidays.
BenefitsL.A. Care offers a wide range of benefits including:
- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental, and Vision
- Wellness Program
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