Customer Solution Center Service Representative II

Customer Solution Center Service Representative II

The Customer Solution Center (CSC) Representative II has advanced knowledge of healthcare and various managed care product lines, including Medi-Cal, PASC, L.A. Care Covered / Cal Medi-Connect and is proficient in medical terminology. The position responsibilities include duties such as : assist supporting queues and management with projects as needed (e.g. provide informative feedback on desktop procedures, follow-up on member inquiries, CSC Representative shadowing etc.), acting as back-up support to Call Center Leads. This position handles inbound and outbound interactions involving member eligibility verification, general provider inquiries, claim status (pre-payment), general program and administration questions for all lines of business including direct member request for I.D cards and Primary Care Physician (PCP) changes, triages calls to appropriate units or outside entities and processes payments for L.A. Care Covered members. All interactions are documented in system of record.

Answers incoming calls for all product lines from members, potential members, providers and advocates. Handles and resolves member issues, assists members in connecting with internal units or external parties such as Plan Partners, Primary Care Physician (PCP) offices, pharmacists, etc. Provides essential information to members regarding access to care issues, coordination of care issues, benefits, Evidence of Coverage (EOC), Member Handbook, etc. Assists providers in using the Interactive Voice Response (IVR) web portal and verifying member eligibility. Documents all calls via the member data base systems. (60%)

Processes payments for L.A. Care Covered members. (15%)

Supports robocall and ad-hoc member outreach activities as determined by business need. (15%)

Performs other duties as assigned. (10%)

High School Diploma / or High School Equivalency Certificate

At least 1 year of customer service call center experience in a healthcare environment.

Data entry experience with ability to type a minimum of 40 wpm.

Knowledge of medical terminology.

Good understanding of service to the disadvantaged population, seniors and or people with chronic conditions or disabilities.

Must be a quick learner, excellent team player and customer service oriented.

Ability to answer a high volume of calls.

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.

L.A. Care Health Plan Call Center is available 24 hours a day, 7 days a week, including holidays. Call Center work shifts are assigned based on business need and may include, but not be limited to, evenings, weekends and holidays.

Salary Range Disclaimer : The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

L.A. Care offers a wide range of benefits including Paid Time Off (PTO), Tuition Reimbursement, Retirement Plans, Medical, Dental and Vision, Wellness Program, Volunteer Time Off (VTO).