Customer Service Representative

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

At this time, the Health Plan does not sponsor visa. Candidates must have legal and valid work authorization, Green Card, or U.S. citizenship.

Under direct supervision, the Customer Service Rep is responsible for responding to and resolving a variety of inquiries, requests and issues from external and internal customers in a call center environment.

Continuously improve the health of our community.

We provide healthcare value and advance wellness through community partnerships.

• Provides information on benefits, eligibility, claims, authorizations and other related items over the phone and in person.
• Researches and resolves issues related to claims and authorizations; monitors progress.
• Researches and resolves complex eligibility issues; monitors progress.
• Creates required documentation, including but not limited to call logs and other tracking systems.

• Produces work that is accurate and complete.
• Actively learns through experimentation when tackling new problems, using both successes and failures to learn.
• Rebounds from setbacks and adversity when facing difficult situations.
• Knows the most effective and efficient process to get things done, with a focus on continuous improvement.
• Interpersonal skills - interacts effectively with individuals both inside and outside of HPSJ; relates openly and comfortably with diverse groups of people.
• Strong oral and written communication skills, with ability to express self clearly and professionally, and document according to standards.
• Strong listening skills, with the ability to accurately receive and understand messages.
• Basic conflict resolution skills, with the ability to use tact and diplomacy to diffuse emotional situations.
• Ability to work independently and as part of a team.
• Demonstrates a commitment to HPSJ’s strategy, vision, mission and values.
• Ability to read, understand and apply complex written guidelines, instructions and other materials.
• Ability to compare and discern the difference between multiple sets of data or information.
• Basic arithmetic skills.
• Basic knowledge of contact center systems.
• Basic skills in Windows, Word, Excel and Outlook.
• Ability to navigate multiple systems and resources simultaneously.
• Ability to handle confidential information with appropriate discretion.
• Ability to speak and be understood in English.
• Proficiency (as defined by HPSJ’s Cultural and Linguistics Program) in one of HPSJ’s threshold languages may be required, depending on business requirements.
• Must type 40 WPM.
• Must pass Call Center Listening Skill test with a score of 71+.

• Ability to efficiently and effectively handle calls of heavy volume ( 50-100 per day), including documentation and resolution.
• Knowledge of Medi-Cal programs
• Knowledge of Medicare DSNP programs
• Knowledge of managed care
• Knowledge of medical policy benefits and exclusions
• Knowledge of medical terminology
• Knowledge of ICD and CPT coding.

• High school diploma or general education degree; and
• Customer Service experience.

• Associate’s Degree
• Experience in customer service in a health plan, managed care, Medicare DSNP and/or Medi-Cal.
• At least one year handling heavy call volume (50-100 calls per day).

None.

• Competitive salary
• Robust and affordable health/dental/vision with choices in providers
• Generous paid time off (accrue up to 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays)
• CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution plan
• Two flexible spending accounts (FSAs)
• Employer-Paid Term Life and AD&D…