Customer Solution Center Service Representative III - L.A. Care Health Plan : Job Details

Customer Solution Center Service Representative III

Job Category: Customer Service

Want to make an application Make sure your CV is up to date, then read the following job specs carefully before applying.

Department: Customer Solution Call Center

Location: Los Angeles, CA, US, 90017

Position Type: Full Time

Requisition ID: 11646

Salary Range: $55,245.00 (Min.) - $69,045.00 (Mid.) - $82,867.00 (Max.)

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan, serving more than 2 million members.

Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents.

Under the general direction of leadership and management in the Customer Solution Center, the Customer Solution Center Service Representative III handles provider inquiries and issue resolution of Level One (1) inquiries, including general inquiries on claims processing and eligibility verification. This position also provides support to members on inbound calls as part of the larger role of 'one-stop shop' service in the Customer Solution Center and acts as a Subject Matter Expert, serving as a resource and mentor for other staff.

Duties

Assist providers in response to telephonic and electronic inquiries and concerns on all products and paid/unpaid claims, ensuring accurate information is provided in a timely manner.

Handle Level One (1) provider inquiries, including general inquiries on claims processing, payment status, and eligibility verification.

Document interactions with providers, including resolution or escalation steps in the system of record for each call.

Escalate Level Two (2) provider concerns to the Claims Department for resolution.

Apply subject expertise in evaluating business operations and processes, identifying areas for improvement.

Provide training, recommend process improvements, and mentor junior staff as needed.

Support the Call Center in meeting State regulatory requirements by handling member-related inbound calls.

Perform special projects and ad-hoc assignments as necessary.

Perform other duties as assigned.

Education Required

Required: At least 2 years of experience in customer service in a high-call-volume healthcare customer service call center, including a minimum of 2 years of general claims inquiry or managed care specialty line of business experience.

Customer service training in a healthcare environment.

Data entry experience with the ability to type a professional minimum of 35 wpm.

Skills

Required: Working knowledge of Microsoft Office Suite (Word, Excel, PowerPoint, Outlook).

Excellent communication skills (written and verbal).

Ability to navigate multiple programs/databases while assisting each caller.

Proficient knowledge in healthcare product lines, medical terminology, and claims processes.

Licenses/Certifications RequiredLicenses/Certifications PreferredRequired Training

Preferred: Technical training/certificate in a technical or business school (e.g., medical billing, medical terminology, medical coding, healthcare).

Physical Requirements

Light

Additional Information

Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

L.A. Care offers a wide range of benefits including:

• Paid Time Off (PTO)
• Tuition Reimbursement
• Retirement Plans
• Medical, Dental and Vision
• Wellness Program

Nearest Major Market: Los Angeles

Job Segment: Claims, Call Center Representative, Customer Service Representative, Medical Coding, Data Entry, Insurance, Customer Service, Healthcare, Administrative

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