Medical Customer Service Representative

1 week ago

Orange, United States WOTM - Partners Professional Full time
Job DescriptionJob Description

Job Summary

We are seeking highly motivated and experienced Customer Service Representatives (6) to join our team in Orange, CA 92868. The Customer Service Representative (CSR) will be the first line of contact for members and providers. The incumbent will assist with questions and/or complaints related to the Medi-Cal programs for Orange County. Provide information regarding eligibility, enrollment, benefits and services to eligible members and providers. This is a full time, onsite-contract role with work schedule from Monday-Friday, hours from 8:30am-5:30pm. Compensation range from $23.00 to $27.00/hr. D.O.E. Tentative Start Feb. 3rd 2025

Duties & Responsibilities:

- 80% - Program Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Maintains departmental productivity and quality standards. Follows through on and completes all member and provider inquiries or requests during the original member and provider interaction. Serves as a resource for other team members.
- Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
- Maintains departmental productivity and quality standards.
- Follows through on and completes all member and provider inquiries or requests during the original member and provider interaction.
- Serves as a resource for other team members.
- 15% - Administrative Support Assists the team in carrying out department responsibilities and collaborates with others to support short and long-term goals/priorities for the department. Addresses 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. Enters accurate and complete documentation into internal application systems regarding all concerns and/or inquiries from the member and provider interaction. Communicates, builds and maintains internal and external relationships by prompt and accurate service delivery. Identifies and communicates challenges that might arise with the use of professional judgment while adhering to departmental policies and procedures.
- Assists the team in carrying out department responsibilities and collaborates with others to support short and long-term goals/priorities for the department.
- Addresses 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.
- Enters accurate and complete documentation into internal application systems regarding all concerns and/or inquiries from the member and provider interaction.
- Communicates, builds and maintains internal and external relationships by prompt and accurate service delivery.
- Identifies and communicates challenges that might arise with the use of professional judgment while adhering to departmental policies and procedures.
- 5% - Completes other projects and duties as assigned

 

Minimum Qualifications:

-High School diploma or equivalent required. 6 months of experience in a call center capacity required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.

- Typing speed of 35 words per minute (WPM).

- Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Preferred Qualifications:

- 6 months of Medi-Cal/Medicaid or health services experience.

Knowledge & Abilities:

- Develop rapport and establish and maintain effective working relationships with leadership and staff and external contacts at all levels and with diverse backgrounds.
- Work independently and exercise sound judgment.
- Communicate clearly and concisely, both orally and in writing.
- Work a flexible schedule; available to participate in evening and weekend events.
- Organize, be analytical, problem-solve and possess project management skills.
- Work in a fast-paced environment and in an efficient manner.
- Manage multiple projects and identify opportunities for internal and external collaboration.
- Motivate and lead multi-program teams and external committees/coalitions.

Company DescriptionOur Professional Division works with clients as a stakeholder in their hiring strategy and process. We facilitate a solid match for our employees and clients, examining the experience and team dynamics required for a great match. Our professional team was handpicked from 25 years of recruiting and staffing experience to build our Professional team to be the best in the industry. We focus on professional placements in your Executive Placement, Accounting & Finance, Human Resources, and Administrative Support areas. We place candidates leveraging direct hire, contract-to-hire, contingent, and “Smart Hire” modalities.Company DescriptionOur Professional Division works with clients as a stakeholder in their hiring strategy and process. We facilitate a solid match for our employees and clients, examining the experience and team dynamics required for a great match. Our professional team was handpicked from 25 years of recruiting and staffing experience to build our Professional team to be the best in the industry. We focus on professional placements in your Executive Placement, Accounting & Finance, Human Resources, and Administrative Support areas. We place candidates leveraging direct hire, contract-to-hire, contingent, and “Smart Hire” modalities.

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