Customer Service Representative, Claims Whittier, CA

6557 Greenleaf Ave., Whittier, California

The Customer Service Representative is the primary liaison between callers (members and the general public) and the medical group. Customer Service Representatives will field inquiries across a wide range of healthcare issues and subjects. They will be required to have considerable knowledge about the hospital, the medical staff, the integrated delivery system, the community, health plans, and the sources of information relevant to this data.

PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Downey Hospital, PIH Health Good Samaritan Hospital, PIH Health Whittier Hospital, 37 outpatient medical office buildings, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women’s health, urgent care and emergency services.

The organization is nationally recognized for excellence in patient care and patient experience, and the College of Healthcare Information Management Executives (CHIME) has identified PIH Health as one of the nation’s top hospital systems for best practices, cutting‑edge advancements, quality of care and healthcare technology.

• Self-motivated.
• Excellent verbal and written skills.
• Ability to learn quickly.
• Deal effectively in a fast-paced, changing environment.
• Good organizational skills.
• Ability to work independently as well as be part of a team.
• Develops effective working relationships with all levels of the organization, including administration, doctors, and staff.
• Ability to identify and solve problems.
• The ability to talk to callers in all walks of life and in all situations via telephone and build a sense of trust and rapport with the caller and intent of the call.
• The ability to understand the requirements of a substantial number of health plans, in order to assist patients in selecting a physician, accessing services, and resolving billing issues.
• The ability to record information, in a database, accurately and rapidly.
• Respond to caller inquiries by summarizing what is often confusing and difficult to understand information.
• The ability to perform well in a teamwork environment and to maintain a positive attitude in a busy and high‑pressure work situation.
• The demonstrated ability to speak and write in articulate and grammatically correct English and also converse in Spanish or Chinese if identified in the specific position requirements.

Required:

• High school graduate or equivalent required.
• Experience working with telephone callers, preferably in a healthcare setting, or the ability to demonstrate the aptitude for such work.
• Training or experience in a Microsoft Windows environment required.

Preferred:

• Fluency in Spanish or Chinese preferred.
• Training or experience in any highly interactive environment will be viewed as an important characteristic in any applicant to this position.
• Knowledge of HIPAA compliance issues as they relate to patient protected health information (PHI). Safeguards and preserves the confidentiality of patient’s protected health information in accordance with State and Federal (HIPAA) regulatory requirements, hospital, and departmental policies.
• Experience, training, or background in any health or medical field is desirable.