Customer Service Rep, Covered

Join Us in this Amazing Opportunity The Team You’ll Join

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.

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.

• 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.

• 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.

• 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.

• 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…