Customer Service Representative (Bilingual Required)

Job Description
Department(s): Customer Service
Reports to: Supervisor, Customer Service
FLSA status: Non-Exempt
Salary Grade: C - $20.81 - $28.03 ($43,281 - $58,300)

About CalOptima Health

CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay!

About the Position

The Customer Service Representative (CSR) is the first line of contact for CalOptima Health's members and providers. The incumbent will assist members and providers with questions related to the Medi-Cal programs for Orange County. The incumbent will resolve member inquiries and complaints fairly and effectively. The incumbent will provide information regarding eligibility, enrollment, benefits and services to CalOptima Health's eligible members and providers.

Duties and Responsibilities:

• Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• 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.
• Identifies and communicates challenges that might arise with the use of professional judgement while adhering to departmental policies and procedures.
• Serves as a mediator to ensure the interests of members and CalOptima Health are protected.
• Follows through on and completes all member and provider inquiries or requests.
• Enters accurate, complete and correct documentation into Facets regarding all issues and/or inquires, complaints and grievances.
• Serves as a resource for other team members.
• Functions efficiently and productively in a high-volume telephone call center.
• Maintains departmental productivity and quality standards.
• Completes other projects and duties as assigned.

Experience & Education:

• High School diploma or equivalent required.
• 6 months of customer service experience required.
• Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese) required.
• An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.

Preferred Qualifications:

• Health Maintenance Organization (HMO), Medi-Cal/Medicaid and health services experience.
• 3-6 months of call center experience.
• Typing speed of 40 words per minute (WPM).

About our Benefits & Wellness options:

At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options.

CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.

If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.



Job Location: Orange, California
Position Type:

To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4160

jeid-6498003545ed3a47abf9570740e24b26