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Customer Service Representative
1 month ago
The Customer Service Representative Sr is the first point of contact for members and providers, assisting with questions related to Medical programs for Orange County. The incumbent resolves member inquiries and complaints fairly and effectively, providing information on eligibility, enrollment, benefits, and services to eligible members and providers.
Key Responsibilities
- Participate in a mission-driven culture of high-quality performance, focusing 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.
- Accurately document all issues, inquiries, complaints, and grievances into Facets.
- 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 member transportation requests within one business day of receipt and coordinate with the clinic, provider, and member as necessary.
- Assist members with 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.
- High School diploma or equivalent required.
- 2 years of experience in a customer/member service or call center capacity required.
- Bilingual in English and one of the defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese) required.
- 2 years of Health Maintenance Organization (HMO), Medical/Medicaid, and health services experience preferred.
- 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.
