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.
Company Overview
CalOptima is a county organized health system that provides health insurance programs. It was founded in 1993, and is headquartered in Orange, California, USA, with a workforce of 1001-5000 employees. Its website is https://www.caloptima.org/.