Job Description

We are currently seeking a highly motivated an experienced Customer Service Representative to join our team. The Customer Service Representative (CSR) will be the first line of contact for CalOptima Health’s members and providers. The incumbent will assist members and providers with questions and/or complaints related to the Medi-Cal programs for Orange County. The incumbent will provide information regarding eligibility, enrollment, benefits and services to CalOptima Health’s eligible members and providers.

Position Information:

- Department: Customer Service

- Salary Grade: 301 - $23.00 - $31.0500

- Work Arrangement: Full Office in Orange, CA

Duties & Responsibilities:

- 80% - Program Support 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.

- 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.

- 15% - Administrative Support 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.

- 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.

- 5% - Completes other projects and duties as assigned.

Minimum Qualifications:

- 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.

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