Sr. Customer Service Representative

Sr. Customer Service Representative

Cal Optima

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 Sr. Customer Service Representative 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 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 Sr will serve as the senior point of contact for Cal Optima 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 Cal Optima Health's eligible members and providers. Together, we are building a stronger, more equitable health system.

• 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.

• 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.

• 1 year of Medi-Cal/Medicaid or health services experience.

• 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…