Customer Service Rep

Title: Customer Service Representative

Duration: up to 6 months

Compensation: $23.00 $31.05/hour

Description: The Customer Service Representative is the first line of contact for Health Plan members and providers and will assist them with questions related to the Medi-Cal programs for Orange County. The incumbent resolves member inquiries and complaints fairly and effectively. The incumbent provides information regarding eligibility, enrollment, benefits and services to Health Plans eligible members and providers.

What You Will Do:

• 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.
• 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.
• 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.
• 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.

You Will Be Successful If:

• Establish and maintain effective working relationships with leadership and staff.
• Function efficiently and productively in a high-volume call center.
• Learn procedures and regulations governing member eligibility and the terminology and documents used while remaining knowledgeable of Medi-Cal benefits and procedures.
• Hear and speak well enough to converse on the phone and in person.
• Understand and follow oral and written directions.
• Speak, understand, read and/or write a second language in addition to English may be required for some assignments.
• Communicate clearly and concisely, both orally and in writing.
• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems (e.g., Facets) to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
• Principles and practices of managed health care, health care systems, and medical terminology.
• Principles and techniques for handling customer service issues.
• Personal computers, keyboarding, and appropriate software to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
• Customer service principles and practices.

What You Will Bring:

• High School diploma or equivalent required.
• 6 months of experience in a customer/member service or call center capacity required.
• 6 months of Health Maintenance Organization, Medi-Cal/Medicaid experience preferred

About Impresiv Health:

Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.

Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.

That's Impresiv!