Customer Service Representative - V Group : Job Details

Client: CalOptima Health

Job Title: Customer Service Representative

Duration: 06 Months

Start Date: ASAP

Location: 505 City Parkway West, Orange, CA 92868 (100% Onsite)

Position Type: Contract

Department: Customer Service

Note:

• Training Schedule: 8:30am-5:30pm (1hour lunch)
• Post-Training Schedule is between CalOptima Health CS business hours: 8:00 AM 5:30 PM (8 hours with 30 mins- 1 hour lunch break)
• Temps will be provided their actual post training schedule during the end of training or sooner.
• Schedule is subjected to change and dependent on business needs however will be communicate with employee at least a day in advance if not more.
• For employees scheduled to end at 5:30PM, they must be able to stay until the call queue clears so there is possibility end time may extend a little beyond 5:30PM.

Description:

• CalOptima Health is seeking a highly motivated an experienced TEMP - Customer Service Representative (Non-Bilingual) to join our team. The Customer Service Representative (CSR) will be the first line of contact for CalOptima Healths members and providers. The incumbent will assist members and providers with questions and/or complaints related to the Medi-Cal programs for Orange County. The incumbent will provide information regarding eligibility, enrollment, benefits and services to CalOptima Healths eligible members and providers.

Duties & Responsibilities:

• 80% - Program Support
• 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.

15% - Administrative Support

• 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.

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

Preferred Qualifications:

• 6 months of Medi-Cal/Medicaid or health services experience.

Knowledge & Abilities:

• Develop rapport and establish and maintain effective working relationships with CalOptima Health'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.
• 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.