Customer Service Representative

CalOptima is a mission-driven community-based organization that serves member health with excellence and dignity. They are seeking a Customer Service Representative to assist members and providers with questions and complaints related to Medi-Cal programs for Orange County, providing information regarding eligibility, enrollment, benefits, and services.

Responsibilities

• 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
• 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
• Completes other projects and duties as assigned

Skills

• High School diploma or equivalent PLUS 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) required
• 6 months of Medi-Cal/Medicaid or health services experience

Benefits

• A comprehensive benefits package
• CalPERS pension program and additional retirement packages.
• A generous PTO program
• A quality work life balance
• Various wellness programs
• Tuition Reimbursement
• Professional development opportunities
• Career development opportunities
• Flexible scheduling
• And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.

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