Sr. Customer Service Representative

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.

Cal Optima

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 must work within the State of California only. If Partial Telework, you must also come into the Main Office in Orange, CA, at least two (2) days per week.

• 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 (solving complex challenges, answering uncommon questions and sharing complex processes and procedures).
  • Handles and resolves escalated issues that other representatives cannot resolve.
  • Enters accurate and complete documentation into internal application systems regarding all concerns and/or inquiries from member and provider interactions.
  • 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 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 leadership, 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 work efficiently.
• 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.

• 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…