Customer Service Representative

CalOptima is a mission-driven community-based organization focused on serving member health with excellence and dignity. The Customer Service Representative will be the first line of contact for members and providers, assisting with inquiries related to Medi-Cal programs and ensuring a high standard of customer service.

Responsibilities

• Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability
• Maintains departmental productivity and quality standards
• Follows through on and completes all member and provider inquiries or requests during the original member and provider interaction
• Serves as a resource for other team members
• 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
• Enters accurate and complete documentation into internal application systems regarding all concerns and/or inquiries from the member and provider interaction
• Communicates, builds and maintains internal and external relationships by prompt and accurate service delivery
• Identifies and communicates challenges that might arise with the use of professional judgment while adhering to departmental policies and procedures
• Completes other projects and duties as assigned

Skills

• High School diploma or equivalent PLUS 6 months of experience in a 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) required
• 6 months of Medi-Cal/Medicaid or health services experience

Benefits

• A comprehensive benefits package CalPERS pension program and additional retirement packages.
• A generous PTO program
• A quality work life balance
• Various wellness programs
• Tuition Reimbursement
• Professional development opportunities
• Career development opportunities
• Flexible scheduling

Company Overview