Customer Solution Center Service Representative I
Job Category: Customer Service
Department: Customer Solution Call Center
Location:
Los Angeles, CA, US, 90017
Position Type: Full Time
Requisition ID: 12889
Salary Range: $45,760.00 (Min.) - $47,823.00 (Mid.) - $55,818.00 (Max.)
Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.
Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.
Job Summary
The Customer Solution Center Service Representative I is responsible for a successful completion of the Member Services training program and continues to gain strong knowledge of Medi-Cal and Personal Assistance Services Council (PASC) managed care product lines.
The Customer Solution Center Service Representative I handles first level calls involving member eligibility verification, general program and administration questions, benefits and services, member requests for I.D. cards and Primary Care Provider (PCP) changes, and triage of calls to appropriate units or outside entities.
Answers incoming first level calls 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 system, QMEIS.
Ensures department compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations relating to protection of personal history information. Troubleshoots and directs calls to the appropriate departments or outside entities. (75%)
Supports robocall and ad-hoc member outreach activities as determined by business need. (15%)
Perform other duties as assigned. (10%)
Required:
At least 6 months of customer service call center experience.
Data entry experience with ability to @type a minimum of 40 words per minute.
Preferred:
Managed care or health plan experience.
Required:
Ability to answer a high volume of calls.
Knowledge of medical terminology.
Must be a strong team player, punctual, and has excellent attendance record.
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.
Preferred:
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.
Duties
The Customer Solution Center Service Representative I is responsible for a successful completion of the Member Services training program and continues to gain strong knowledge of Medi-Cal and Personal Assistance Services Council (PASC) managed care product lines.
The Customer Solution Center Service Representative I handles first level calls involving member eligibility verification, general program and administration questions, benefits and services, member requests for I.D. cards and Primary Care Provider (PCP) changes, and triage of calls to appropriate units or outside entities.
Answers incoming first level calls 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 system, QMEIS.
Ensures department compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations relating to protection of personal history information. Troubleshoots and directs calls to the appropriate departments or outside entities. (75%)
Supports robocall and ad-hoc member outreach activities as determined by business need. (15%)
Perform other duties as assigned. (10%)
Required:
At least 6 months of customer service call center experience.
Data entry experience with ability to @type a minimum of 40 words per minute.
Preferred:
Managed care or health plan experience.
Required:
Ability to answer a high volume of calls.
Knowledge of medical terminology.
Must be a strong team player, punctual, and has excellent attendance record.
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.
Preferred:
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.
Duties Continued
The Customer Solution Center Service Representative I is responsible for a successful completion of the Member Services training program and continues to gain strong knowledge of Medi-Cal and Personal Assistance Services Council (PASC) managed care product lines.
The Customer Solution Center Service Representative I handles first level calls involving member eligibility verification, general program and administration questions, benefits and services, member requests for I.D. cards and Primary Care Provider (PCP) changes, and triage of calls to appropriate units or outside entities.
Answers incoming first level calls 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 system, QMEIS.
Ensures department compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations relating to protection of personal history information. Troubleshoots and directs calls to the appropriate departments or outside entities. (75%)
Supports robocall and ad-hoc member outreach activities as determined by business need. (15%)
Perform other duties as assigned. (10%)
Required:
At least 6 months of customer service call center experience.
Data entry experience with ability to @type a minimum of 40 words per minute.
Preferred:
Managed care or health plan experience.
Required:
Ability to answer a high volume of calls.
Knowledge of medical terminology.
Must be a strong team player, punctual, and has excellent attendance record.
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.
Preferred:
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.
Education Required
Instills Trust
Collaborates
Ensures Accountability
Communicates Effectively
Drives Results
Optimizes Work Processes
Action Oriented
Nimble Learning
High School Diploma/or High School Equivalency Certificate
Light
Education Preferred
Instills Trust
Collaborates
Ensures Accountability
Communicates Effectively
Drives Results
Optimizes Work Processes
Action Oriented
Nimble Learning
High School Diploma/or High School Equivalency Certificate
Light
Experience
The Customer Solution Center Service Representative I is responsible for a successful completion of the Member Services training program and continues to gain strong knowledge of Medi-Cal and Personal Assistance Services Council (PASC) managed care product lines.
The Customer Solution Center Service Representative I handles first level calls involving member eligibility verification, general program and administration questions, benefits and services, member requests for I.D. cards and Primary Care Provider (PCP) changes, and triage of calls to appropriate units or outside entities.
Answers incoming first level calls 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 system, QMEIS.
Ensures department compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations relating to protection of personal history information. Troubleshoots and directs calls to the appropriate departments or outside entities. (75%)
Supports robocall and ad-hoc member outreach activities as determined by business need. (15%)
Perform other duties as assigned. (10%)
Required:
At least 6 months of customer service call center experience.
Data entry experience with ability to @type a minimum of 40 words per minute.
Preferred:
Managed care or health plan experience.
Required:
Ability to answer a high volume of calls.
Knowledge of medical terminology.
Must be a strong team player, punctual, and has excellent attendance record.
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.
Preferred:
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.
Skills
The Customer Solution Center Service Representative I is responsible for a successful completion of the Member Services training program and continues to gain strong knowledge of Medi-Cal and Personal Assistance Services Council (PASC) managed care product lines.
The Customer Solution Center Service Representative I handles first level calls involving member eligibility verification, general program and administration questions, benefits and services, member requests for I.D. cards and Primary Care Provider (PCP) changes, and triage of calls to appropriate units or outside entities.
Answers incoming first level calls 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 system, QMEIS.
Ensures department compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations relating to protection of personal history information. Troubleshoots and directs calls to the appropriate departments or outside entities. (75%)
Supports robocall and ad-hoc member outreach activities as determined by business need. (15%)
Perform other duties as assigned. (10%)
Required:
At least 6 months of customer service call center experience.
Data entry experience with ability to @type a minimum of 40 words per minute.
Preferred:
Managed care or health plan experience.
Required:
Ability to answer a high volume of calls.
Knowledge of medical terminology.
Must be a strong team player, punctual, and has excellent attendance record.
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.
Preferred:
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.
Licenses/Certifications Required
Instills Trust
Collaborates
Ensures Accountability
Communicates Effectively
Drives Results
Optimizes Work Processes
Action Oriented
Nimble Learning
High School Diploma/or High School Equivalency Certificate
Light
Licenses/Certifications Preferred
Instills Trust
Collaborates
Ensures Accountability
Communicates Effectively
Drives Results
Optimizes Work Processes
Action Oriented
Nimble Learning
High School Diploma/or High School Equivalency Certificate
Light
Required Training
The Customer Solution Center Service Representative I is responsible for a successful completion of the Member Services training program and continues to gain strong knowledge of Medi-Cal and Personal Assistance Services Council (PASC) managed care product lines.
The Customer Solution Center Service Representative I handles first level calls involving member eligibility verification, general program and administration questions, benefits and services, member requests for I.D. cards and Primary Care Provider (PCP) changes, and triage of calls to appropriate units or outside entities.
Answers incoming first level calls 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 system, QMEIS.
Ensures department compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations relating to protection of personal history information. Troubleshoots and directs calls to the appropriate departments or outside entities. (75%)
Supports robocall and ad-hoc member outreach activities as determined by business need. (15%)
Perform other duties as assigned. (10%)
Required:
At least 6 months of customer service call center experience.
Data entry experience with ability to @type a minimum of 40 words per minute.
Preferred:
Managed care or health plan experience.
Required:
Ability to answer a high volume of calls.
Knowledge of medical terminology.
Must be a strong team player, punctual, and has excellent attendance record.
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.
Preferred:
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.
Physical Requirements
Instills Trust
Collaborates
Ensures Accountability
Communicates Effectively
Drives Results
Optimizes Work Processes
Action Oriented
Nimble Learning
High School Diploma/or High School Equivalency Certificate
Light
Additional Information
The Customer Solution Center Service Representative I is responsible for a successful completion of the Member Services training program and continues to gain strong knowledge of Medi-Cal and Personal Assistance Services Council (PASC) managed care product lines.
The Customer Solution Center Service Representative I handles first level calls involving member eligibility verification, general program and administration questions, benefits and services, member requests for I.D. cards and Primary Care Provider (PCP) changes, and triage of calls to appropriate units or outside entities.
Answers incoming first level calls 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 system, QMEIS.
Ensures department compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations relating to protection of personal history information. Troubleshoots and directs calls to the appropriate departments or outside entities. (75%)
Supports robocall and ad-hoc member outreach activities as determined by business need. (15%)
Perform other duties as assigned. (10%)
Required:
At least 6 months of customer service call center experience.
Data entry experience with ability to @type a minimum of 40 words per minute.
Preferred:
Managed care or health plan experience.
Required:
Ability to answer a high volume of calls.
Knowledge of medical terminology.
Must be a strong team player, punctual, and has excellent attendance record.
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.
Preferred:
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)
