Customer Service Representative

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, join us in building healthier communities for all.

About the role

As a Customer Service Representative, you will be an integral part of our CS - Medi-Cal Call Center team, helping to strive for excellence while serving our members with dignity and respect. This position is approved for Full Office work. If telework is approved, you are required to work within the State of California only. For Partial Telework, you must come into the Main Office in Orange, CA, at least two days per week minimum.

You will be the first line of contact for CalOptima Health's members and providers, assisting 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 eligible members and providers.

Responsibilities

• Program Support (80%)
  • Participate in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity, and accountability.
  • Maintain departmental productivity and quality standards.
  • Follow through on and complete all member and provider inquiries or requests during the original interaction.
  • Serve as a resource for other team members.
• Administrative Support (15%)
  • Assist the team in carrying out department responsibilities and collaborate with others to support short and long-term goals/priorities.
  • Address 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.
  • Enter accurate and complete documentation into internal application systems regarding all concerns and/or inquiries from member and provider interactions.
  • Communicate, build, and maintain internal and external relationships through prompt and accurate service delivery.
  • Identify and communicate challenges that might arise using professional judgment while adhering to departmental policies and procedures.
• Other (5%)
  • Complete other projects and duties as assigned.

Requirements

• High School diploma or equivalent plus 6 months of experience in a call center capacity; an equivalent combination of education and experience may also qualify.
• Typing speed of 35 words per minute (WPM).

Preferred Qualifications

• 6 months of Medi-Cal/Medicaid or health services experience.

Skills

• Develop rapport and establish effective working relationships with 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, analyze, problem-solve, and manage projects effectively.
• Work efficiently in a fast-paced environment.
• 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.

Physical Requirements

• Ability to visually read information from computer screens, forms, and other printed materials.
• 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, reaching, flexibility, body movement for bending, crouching, walking, kneeling, and prolonged sitting.
• Lifting and moving objects, patients, and/or equipment weighing 10 to 25 pounds.

Benefits

• Competitive compensation: Pay Grade 301 - $47,840 - $64,584 ($23.00 - $31.05/hour). The final salary offered will be based on education, job-related knowledge, experience, skills, and internal equity.
• Comprehensive benefits package.
• CalPERS pension program and additional retirement packages.
• Generous PTO program.
• Work-life balance initiatives.
• Wellness programs.
• Tuition reimbursement.
• Professional and career development opportunities.
• Flexible scheduling.

Work Environment

If located at the 505 Building or a remote work location:

• Work is typically indoors and sedentary, subject to schedule changes and/or variable work hours, with travel as needed.
• No harmful environmental conditions present.
• Moderate noise level.

If located at PACE:

• Work is typically indoors in a clinical setting serving the frail and elderly.
• May involve harmful or hazardous environmental conditions.
• Moderate to loud noise level.

If located in the community:

• Work is typically indoors and sedentary, subject to schedule changes and/or variable work hours, with travel as needed.
• Occasional outdoor work in varied temperatures.
• May involve harmful or hazardous environmental conditions.
• Moderate to loud noise level.