We are seeking a highly motivated an experienced Bilingual Customer Service Representative (6) to join our team in Orange, CA 92868. The Customer Service Representative will serve as a senior point of contact for members and providers and will assist them with questions and/or complaints related to their plan services. This is a full time, onsite-contract role with work schedule from Monday-Friday, hours from 9am-5:30pm. Compensation range from $23.00 to $25.00/hr.
Duties & Responsibilities:
95% - Program Support Participates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. 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. Serves as a
senior resource for other team members (i.e., solves complex challenges, answers uncommon questions and shares complex processes and procedures). Supports in the coordination of member's health care and social service needs both within and outside the medical group and company. Enters accurate and complete documentation into internal application systems regarding all concerns and/or inquiries from the member and provider interaction. Initiates referrals to both internal and external care management departments and other department/government or community agencies. 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. Provides additional follow-up assistance as needed.
Participates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
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.
Serves as a senior resource for other team members (i.e., solves complex challenges, answers uncommon questions and shares complex processes and procedures).
Supports in the coordination of member's health care and social service needs both within and outside the medical group and company.
Enters accurate and complete documentation into internal application systems regarding all concerns and/or inquiries from the member and provider interaction.
Initiates referrals to both internal and external care management departments and other department/government or community agencies.
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. Provides additional follow-up assistance as needed.
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.
Bilingual in English and in one of defined threshold languages (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese) required.
Preferred Qualifications:
- 6 months of health maintenance organization (HMO), Medi-Cal/Medicaid and health services experience.
- Typing speed of 35 words per minute (WPM).
Knowledge & Abilities:
Develop rapport and establish and maintain effective working relationships with company's 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.
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.
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.