Demo

Customer Service Representative I

Partnership HealthPlan of California
Fairfield, CA Full Time
POSTED ON 4/4/2025
AVAILABLE BEFORE 4/3/2026

Overview

The Customer Service Representative I will answer and resolve provider telephone and written inquiries within established time frames. This position will accurately screen correspondence, perform research, refer to appropriate team as necessary, track follow-up to ensure completion, document all interactions with providers, research and complete various tasks, as appropriate for individual roles, such as claims review, provider dispute resolutions, provider surveys, provider change forms and paper and electronic correspondence within established time frames, applying appropriate program policies.

Responsibilities

▪ Responds to provider telephone inquiries, researches policy issues, analyzes provider concerns, recommends resolution to the issues, collaborates with other departments as necessary and documents all provider communication and actions taken.▪ Researches and communicates outcome to providers regarding inquiries and requests within established time frames.▪ Follows established Partnership policies and procedures, Partnership operating instruction memorandums, EDS provider manual guidelines, and Title 22 regulations when resolving claims or provider issues.▪ Recognizes and gives feedback to management on procedure changes that would result in more efficient operations.▪ Records daily production statistics and related activities on appropriate reports; turns all logs and reports in to Supervisor.▪ Meets established production and call performance metrics as determined.▪ Participates in special projects and assignments as required.▪ Other duties as assigned.

Qualifications

Education and Experience

High school diploma or equivalent; Customer service experience and one (1) year of prior claims processing experience in an automated claim environment preferred; or equivalent combination of education and experience.

 

Special Skills, Licenses and Certifications

 

 

Knowledge of CPT, HCPC procedure coding, and ICD-10 diagnostic coding preferred but not required. Knowledge of medical terminology preferred. Ability to access coding reference guides for accurate information. Typing speed 30 wpm and proficient use of 10-key calculator.

 

Performance Based Competencies

 

 

Excellent written and oral communication skills. Ability to effectively exercise good judgment within scope of authority and handle sensitive issues with tact and diplomacy. Good organizational skills. Ability to accurately complete tasks within established time frames.

 

 

Work Environment And Physical Demands

Ability to use a computer keyboard. More than 80% of work time is spent in front of a computer monitor; when required, ability to move, carry, or lift objects of varying size weighing up to 25 lbs.

 

 

 

All HealthPlan employees are expected to:

 

  • Provide the highest possible level of service to clients;
  • Promote teamwork and cooperative effort among employees;
  • Maintain safe practices; and
  • Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

HIRING RANGE:

 

$28.94 - $34.00

 

IMPORTANT DISCLAIMER NOTICE

 

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

Salary : $29 - $34

If your compensation planning software is too rigid to deploy winning incentive strategies, it’s time to find an adaptable solution. Compensation Planning
Enhance your organization's compensation strategy with salary data sets that HR and team managers can use to pay your staff right. Surveys & Data Sets

What is the career path for a Customer Service Representative I?

Sign up to receive alerts about other jobs on the Customer Service Representative I career path by checking the boxes next to the positions that interest you.
Income Estimation: 
$35,979 - $45,091
Income Estimation: 
$41,527 - $53,091
Income Estimation: 
$35,979 - $45,091
Income Estimation: 
$41,527 - $53,091
Income Estimation: 
$41,527 - $53,091
Income Estimation: 
$47,809 - $60,449
Income Estimation: 
$51,050 - $68,081
Income Estimation: 
$59,001 - $77,833
Income Estimation: 
$59,001 - $77,833
Income Estimation: 
$73,754 - $99,306
View Core, Job Family, and Industry Job Skills and Competency Data for more than 15,000 Job Titles Skills Library

Job openings at Partnership HealthPlan of California

Partnership HealthPlan of California
Hired Organization Address Fairfield, CA Full Time
Overview The Epidemiologist will work with the Chief Medical Officer and collaboratively with HealthServices leaders and...
Partnership HealthPlan of California
Hired Organization Address Redding, CA Full Time
Overview The Customer Service Representative I will answer and resolve provider telephone and written inquiries within e...
Partnership HealthPlan of California
Hired Organization Address Fairfield, CA Full Time
Overview To provide coordination and implementation support of defined tasks for the assigned program(s). Responsibiliti...
Partnership HealthPlan of California
Hired Organization Address Fairfield, CA Full Time
Overview To plan, organize, manage, and implement projects. Responsibilities Develops and maintains detailed project pla...

Not the job you're looking for? Here are some other Customer Service Representative I jobs in the Fairfield, CA area that may be a better fit.

Customer Service Representative

H&S Energy Group, Martinez, CA

Customer Service Representative

Patterson Companies, Concord, CA

AI Assistant is available now!

Feel free to start your new journey!