What are the responsibilities and job description for the Bilingual Customer Service Representative - Healthcare Provider position at Sunshine Enterprise Inc?

Customer Service Representative (Bilingual)

Company Overview : Our client is a leading healthcare located in Orange, CA, seeking a senior customer service representative, performing as a point of contact for questions and / or complaints related to plan services.

Position Summary : The ideal candidate shall have minimum of two years of customer / member service experience with at least 1 year of call center capacity.

Position Responsibilities

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.
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.
Completes other duties or projects as assigned.

Experience & Education

High School diploma or equivalent required.

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

2 years of claims experience required.

1 year of call center experience with high call volumes or customer service experience analyzing and solving provider claims problems required.

1 year of HMO, Medi-Cal / Medicaid and healthcare / managed care experience strongly preferred.

Bilingual in English and in one of the languages (Arabic, Chinese, Farsi, Korean, Spanish, or Vietnamese) required.

An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.

Necessary Attributes :

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.

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

Ability to visually read information from computer screens, forms and other printed materials and information.

Ability to speak (enunciate) clearly in conversation and general communication.

Hearing ability for verbal communication / conversation / responses via telephone, telephone systems, and face-to-face interactions.

Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.

Lifting and moving objects, patients and / or equipment 10 to 25 pounds

Please see HR for information on physical demands and work environment of this job.

Sunshine Enterprise USA is an Equal Opportunity Employer-Minorities, Females, Veterans and Disabled Persons

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Bilingual Customer Service Representative - Healthcare Provider

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