Customer Service Rep, Covered California

Customer Service Rep, Covered California

Join Us in this Amazing Opportunity

We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.

More About the Opportunity

We are hoping you will join us as a Customer Service Rep, Covered California and help shape the future of healthcare where you'll be an integral part of our Customer Service 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 Rep (Covered CA) will be the first line of contact for Cal Optima Health's members and providers. You'll assist members and providers with questions and/or complaints related to Covered California regarding eligibility, benefits and covered services. Additionally, you'll support members by providing information and directing cases to the appropriate operational teams. Together, we are building a stronger, more equitable health system.

Your Contributions To the Team:

• 95% - Customer Support

• 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.

• Maintains departmental productivity and quality standards.

• Responds to and completes all member and provider inquiries or requests during the initial member and provider interaction.

• Serves as a resource for other team members.

• Addresses member and provider inquiries, questions and concerns in all areas, including eligibility, enrollment, billing, benefits and covered services in-person or telephonically.

• 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.

• Enters accurate and complete documentation into internal application systems regarding all concerns and/or inquiries from the member and provider interaction.

• 5% - Other

• Completes other projects and duties as assigned.

Do You Have What the Role Requires?

• 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.

• Experience with Covered California, health insurance exchange/marketplace and/or commercial Individual and Family Plan required.

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

You'll Stand Out More If You Possess the Following:

• Bilingual in English and in one of Cal Optima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Russian, Spanish, Vietnamese).

• 6 months of Covered California call center experience.

What the Regulatory Agencies Need You to Possess?

• N/A

Your Knowledge & Abilities to Bring to this Role:

• 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 manner.

•…