Customer Service Representative
Job Summary
The Customer Service Representative (CSR) is the first line of contact for Health members and providers. The incumbent will assist members and providers with questions related to the Medi-Cal programs for Orange County. The incumbent will resolve member inquiries and complaints fairly and effectively. The incumbent will provide information regarding eligibility, enrollment, benefits and services to Health’s eligible members and providers.
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.
Communicates, builds and maintains internal and external relationships by prompt and accurate service.
Identifies and communicates challenges that might arise with the use of professional judgement while adhering to departmental policies and procedures.
Serves as a mediator to ensure the interests of members and Health are protected.
Follows through on and completes all member and provider inquiries or requests.
Enters accurate, complete and correct documentation into Facets regarding all issues and/or inquires, complaints and grievances.
Serves as a resource for other team members.
Functions efficiently and productively in a high-volume telephone call center.
Maintains departmental productivity and quality standards.
Completes other projects and duties as assigned.
Possesses the Ability to:
Establish and maintain effective working relationships with Health’s leadership and staff.
Work efficiently and productively with minimal direct supervision.
Collaborate and work in a team.
Handle multiple tasks at the same time.
Apply principles and techniques for handling customer service challenges.
Communicate clearly and concisely, both orally and in writing.
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.
Experience & Education:
High School diploma or equivalent required.
6 months of customer service experience 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.
Preferred Qualifications:
Bilingual in English and in one of Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese).
Health Maintenance Organization (HMO), Medi-Cal/Medicaid and health services experience.
3-6 months of call center experience.
Typing speed of 40 words per minute (WPM).
Knowledge of:
Customer resolution skills.
Basic understanding of managed health care, health care systems and medical terminology.
The Customer Service Representative (CSR) is the first line of contact for Health members and providers. The incumbent will assist members and providers with questions related to the Medi-Cal programs for Orange County. The incumbent will resolve member inquiries and complaints fairly and effectively. The incumbent will provide information regarding eligibility, enrollment, benefits and services to Health’s eligible members and providers.
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.
Communicates, builds and maintains internal and external relationships by prompt and accurate service.
Identifies and communicates challenges that might arise with the use of professional judgement while adhering to departmental policies and procedures.
Serves as a mediator to ensure the interests of members and Health are protected.
Follows through on and completes all member and provider inquiries or requests.
Enters accurate, complete and correct documentation into Facets regarding all issues and/or inquires, complaints and grievances.
Serves as a resource for other team members.
Functions efficiently and productively in a high-volume telephone call center.
Maintains departmental productivity and quality standards.
Completes other projects and duties as assigned.
Possesses the Ability to:
Establish and maintain effective working relationships with Health’s leadership and staff.
Work efficiently and productively with minimal direct supervision.
Collaborate and work in a team.
Handle multiple tasks at the same time.
Apply principles and techniques for handling customer service challenges.
Communicate clearly and concisely, both orally and in writing.
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.
Experience & Education:
High School diploma or equivalent required.
6 months of customer service experience 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.
Preferred Qualifications:
Bilingual in English and in one of Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese).
Health Maintenance Organization (HMO), Medi-Cal/Medicaid and health services experience.
3-6 months of call center experience.
Typing speed of 40 words per minute (WPM).
Knowledge of:
Customer resolution skills.
Basic understanding of managed health care, health care systems and medical terminology.
