Customer Service Representative

6 days ago

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

CalOptima Health is seeking a highly motivated and experienced Customer Service Representative (Non-Bilingual) to join our team. The Customer Service Representative will be the first point of contact for CalOptima Health's members and providers, providing information and assistance with questions and/or complaints related to the Medi-Cal programs for Orange County.

Key Responsibilities
  • 80% - Program Support
    • Participate in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity, and accountability.
    • Maintain departmental productivity and quality standards.
    • Follow through on and complete all member and provider inquiries or requests during the original member and provider interaction.
    • Serve as a resource for other team members.
  • 15% - Administrative Support
    • 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 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.
    • Enter accurate and complete documentation into internal application systems regarding all concerns and/or inquiries from the member and provider interaction.
    • Communicate, build, and maintain internal and external relationships by prompt and accurate service delivery.
    • Identify and communicate challenges that might arise with the use of professional judgment while adhering to departmental policies and procedures.
  • 5% - Complete other projects and duties as assigned.
Requirements
  • 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 may also be qualifying.
Preferred Qualifications
  • 6 months of Medi-Cal/Medicaid or health services experience.
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 working together to strengthen our community's health. We are committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable, and welcoming so we can truly be Better Together.

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