Title: Customer Service Representative (OneCare)
Duration: up to 6 months
Schedule: Monday-Friday 9a-5:30pm
Compensation: $23.00 – $31.05/hour
Description: The Customer Service Representative is the first line of contact for Health Plan members and providers and will assist them with questions related to the Medi-Cal programs for Orange County. The incumbent will assist members and providers with questions related to the OneCare program. The incumbent will provide information regarding eligibility, enrollment, benefits, and services to OneCare-eligible members and providers.
What You Will Do:
- 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.
- Guides members in understanding and accessing the benefits they are entitled to under Medicare and Medi-Cal, through the OneCare program.
- 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.
- Enters accurate and complete documentation into internal application systems regarding all concerns and/or inquiries from the member and provider interaction.
- Initiates referrals to both internal/external care management departments and other departments, governments, or community agencies.
- Participates in departmental phone outreach campaigns on a regular basis.
- Completes other projects and duties as assigned.
You Will Be Successful If:
- Establish and maintain effective working relationships with leadership and staff.
- Function efficiently and productively in a high-volume call center.
- Learn procedures and regulations governing member eligibility and the terminology and documents used while remaining knowledgeable of Medi-Cal benefits and procedures.
- Hear and speak well enough to converse on the phone and in person.
- Understand and follow oral and written directions.
- Speak, understand, read, and/or write a second language in addition to English may be required for some assignments.
- Communicate clearly and concisely, both orally and in writing.
- Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job-specific applications/systems (e.g., Facets) to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
- Principles and practices of managed health care, health care systems, and medical terminology.
- Principles and techniques for handling customer service issues.
- Personal computers, keyboarding, and appropriate software to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
- Customer service principles and practices.
What You Will Bring:
- High School diploma or equivalent required.
- 6+ months of experience in a call center capacity required.
- Bilingual in English and in one of the following defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese) required.
- 6+ months of Health Maintenance Organization, Medi-Cal/Medicaid experience preferred.
- Typing Speed of 35 words per minute (WPM) preferred.
About Impresiv Health:
Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.
Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do – provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.
That's Impresiv!