Customer Service Representative

We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person.

We are hoping you will join us as a Customer Service Representative
and help shape the future of healthcare where you’ll be an integral part of our CS - Medi-Cal Call Center
team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be
Full Office
.

• If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.

The Customer Service Representative (CSR) will be the first line of contact for Cal Optima Health’s members and providers. You will assist members and providers with questions and/or complaints related to the Medi-Cal programs for Orange County. You will provide information regarding eligibility, enrollment, benefits and services to Cal Optima Health’s eligible members and providers. Together, we are building a stronger, more equitable health system.

• 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% - Other-
  • Completes other projects and duties as assigned.

• 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.

• N/A

• Develop rapport and establish and maintain effective working relationships with Cal Optima 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…