Customer Service Representative

23 hours ago

San Jose, California, United States Santa Clara County Health Plan Full time
Job Summary

We are seeking a highly skilled and customer-focused Customer Service Representative I to join our team at Santa Clara County Health Plan. As a key member of our Customer Service Department, you will be responsible for providing exceptional service to our members and providers, ensuring that their needs are met and their concerns are addressed in a timely and professional manner.

Key Responsibilities
  • Answer inbound calls and make outbound calls to support Customer Service Department operations, maintaining compliance with Medicare and Medi-Cal regulatory requirements and achieving Call Center service-level objectives.
  • Act as the primary point of contact and liaison for SCFHP members and providers, responding to general inquiries, concerns, or requests for information.
  • Develop a general understanding of all member-facing materials, communications, and interactions, and be prepared to respond appropriately to follow-up calls.
  • Use listening skills and judgment to appropriately categorize and accurately document all contacts and follow-up actions regarding member and provider communications and activities, in accordance with established guidelines.
  • Identify member and provider issues and trends, and report relevant information to management.
Requirements
  • High School Diploma or GED.
  • Minimum one year of experience in Customer Service or Call Center role, preferably within a Health Care, Public Assistance, or Human Services program.
  • Prior experience with managed care plans, Medi-Cal, and Medicare programs, and working with underserved populations.
  • Ability to meet Key Performance Indicators by participating in and achieving the standards of the Customer Service Call Center Quality Program.
  • Spanish, Vietnamese, Chinese, or Tagalog language bi-lingual skills.
  • Working knowledge of and the ability to efficiently operate all applicable computer software, including computer applications such as Outlook, Word, and Excel.
Working Conditions

Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications.

Physical Requirements

Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation:

  • Regular bending at the waist, and reaching overhead, above the shoulders, and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time.
  • Regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds.
  • Ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less.
  • Regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment.
  • Ability to hear normal speech, hear, and talk to exchange information in person and on telephone.
Environmental Conditions

General office conditions. May be exposed to moderate noise levels.

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