Customer Service Representative Sr

Customer Service Representative Sr

CalOptima

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.

More About the Opportunity

We are hoping you will join us as a Customer Service Representative Sr and help shape the future of healthcare where you'll be an integral part of our CS - Medi-Cal Call Center 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.

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 will serve as the senior point of contact for CalOptima Health members and providers and will assist them with questions and/or complaints related to the Medi-Cal programs for Orange County. You will provide information regarding eligibility, enrollment, benefits and services to CalOptima Health's eligible members and providers. Together, we are building a stronger, more equitable health system.

Your Contributions To the Team:

80% - Program Support

Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.

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

Handles and resolves escalated issues (i.e., customer service representative unable to handle/resolve).

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

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

Identifies and communicates challenges that might arise with the use of professional judgment while adhering to departmental policies and procedures.

15% - Administrative Support

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.

Communicates, builds and maintains internal and external relationships by prompt and accurate service delivery.

Maintains departmental productivity and quality standards.

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 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) is required.

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

1 year of Medi-Cal/Medicaid or 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 CalOptima 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.

Manage multiple projects and identify opportunities for internal and external collaboration.

Motivate and lead multi-program teams and external committees/coalitions.

Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Your Physical Requirements (With or Without Accommodations):

Ability to visually read information from computer screens, forms and other printed materials and information.

Ability to speak (enunciate) clearly in conversation and general communication.

Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.

Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.

Lifting and moving objects, patients and/or equipment 10 to 25 pounds

Ways We Are Here For You

You'll enjoy competitive compensation for this role.

Our current hiring range is: Pay Grade: 302 - $49,754 - $69,655 ($23.92 - $33.4880).

The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors.

This position is approved for Partial Telework (**If the position is Telework, it is eligible in California only**)

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