Part-Time -Customer Service Representative Sr; OneCare; Bilingual

Part-Time
-Customer Service Representative Sr (One Care) (Bilingual Required)

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 Part-Time Customer Service Representative Sr (One Care) (Bilingual Required) and help shape the future of healthcare where you'll be an integral part of our CS - One Care 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 Partial Telework.

Part-time will be 20 - 28 hrs. per week.

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 Sr (One Care) will serve as a senior point of contact for One Care members and providers and assist them with questions and/or complaints related to the One Care plan services. You will provide information regarding eligibility, enrollment, benefits and services to One Care eligible members and providers. Together, we are building a stronger, more equitable health system.

Your Contributions To the Team:

• 95% - Program 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.

• 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.

• Serves as a senior resource for other team members (i.e., solves complex challenges, answers uncommon questions and shares complex processes and procedures).

• Supports in the coordination of member's health care and social service needs both within and outside the medical group and Cal Optima Health.

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

• Initiates referrals to both internal and external care management departments and other department/government or community agencies.

• Maintains departmental productivity and quality standards.

• Follows through and completes all member and provider inquiries or requests during the original member and provider interaction. Provides additional follow-up assistance as needed.

• 5% - Other

• Completes other projects and duties as assigned.

Do You Have What the Role Requires?

• High school diploma or equivalent PLUS 2 years of experience in customer/member service, including 1 year of 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.

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

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

• 1 year of Health Maintenance Organization (HMO), Medi-Cal/Medicaid and health services 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.

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