Contact Center Representative II

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan, serving more than 2 million members. Our mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

About the role

The Contact Center Representative (CCR) II is the first point of contact for members, providers, and stakeholders, delivering complete, accurate, and compassionate support on moderately complex issues related to eligibility, benefits, claims, authorizations, Primary Care Physician (PCP) changes, and other service needs, ensuring seamless triage across the healthcare journey. The CCR II delivers a high-quality service experience that supports member retention and health outcomes, focusing on all managed care product lines with an in-depth understanding of Commercial and Medicare products.

Responsibilities

• Responds to inquiries across all channels related to eligibility, benefits, claims, authorizations, and coordination of care.
• Assists members with navigating their healthcare journey, including understanding their eligibility and benefits, Evidence of Coverage (EOC), and Member Handbook.
• Provides First Call Resolution (FCR) by accessing internal tools and external portals to address the needs of members and providers effectively on the first call.
• Supports members and providers with navigation of self-service tools.
• Resolves moderately complex issues requiring coordination with internal departments.
• Captures and reconciles premium billing payments, ensuring accurate calculation of member premiums.
• Initiates Service Authorization Requests (SARs).
• Documents all member interactions in L.A. Care’s system of record.
• Ensures compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations and protects member privacy.
• Triages and directs calls to the appropriate internal teams or external entities for resolution, as needed.
• Maintains current knowledge of benefit plans, regulatory requirements, and internal policies to ensure compliant and accurate information delivery. (80%)
• Supports ad-hoc targeted member outreach activities as determined by business need. (10%)
• Performs other duties as assigned. (10%)

Requirements

• High School Diploma or High School Equivalency Certificate.
• At least 2 years of customer service contact center experience in a healthcare environment.
• Data entry experience with ability to type a minimum of 40 wpm.

Qualifications

• Member Services contact center experience at a Commercial or Medicare Managed Care plan (preferred).

Skills

• Ability to answer a high volume of calls while demonstrating a high level of empathy and patience.
• Knowledge of managed care terminology, specifically in the commercial and Medicare space.
• Familiarity with HIPAA regulations and confidentiality practices.
• Strong verbal and written communication skills.
• Strong probing, problem-solving, and multitasking skills with attention to detail.
• Strong understanding of healthcare operations including claims processing and benefits administration.
• Proficient in contact center systems and Microsoft Office.
• Bilingual in one of L.A. Care Health Plan’s threshold languages is highly desirable: English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese.

Pay

Salary Range: $50,216.00 (Min.) - $62,770.00 (Mid.)

Benefits

• Paid Time Off (PTO)
• Tuition Reimbursement
• Retirement Plans
• Medical, Dental, and Vision
• Wellness Program
• Volunteer Time Off (VTO)

Schedule

L.A. Care Health Plan’s Contact Center is open 24 hours a day, 7 days a week, including holidays. Contact Center work shifts are assigned based on business need and may include evenings, weekends, and holidays.