L.A. Care Health Plan is hiring: Customer Solution Center Service Representative

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: 11781

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.

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.

The Customer Solution Center Service Representative I is responsible for successfully completing the Member Services training program and gaining strong knowledge of Medi-Cal and Personal Assistance Services Council (PASC) managed care product lines.

The representative handles first level calls involving member eligibility verification, general program and administration questions, benefits and services, member requests for I.D. cards, Primary Care Provider (PCP) changes, and triage of calls to appropriate units or outside entities.

Duties

1. Answers incoming first level calls from members, potential members, providers, and advocates.
2. Handles and resolves member issues, assists members in connecting with internal units or external parties such as Plan Partners, PCP offices, pharmacists, etc.
3. Provides essential information to members regarding access to care issues, coordination of care issues, benefits, Evidence of Coverage (EOC), Member Handbook, etc.
4. Assists providers in using the Interactive Voice Response (IVR) web portal and verifying member eligibility.
5. Documents all calls via the member database system, QMEIS.
6. Ensures department compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations relating to the protection of personal history information.
7. Troubleshoots and directs calls to the appropriate departments or outside entities.
8. Supports robocall and ad-hoc member outreach activities as determined by business need.
9. Performs other duties as assigned.

Education and Experience

Required: At least 6 months of customer service call center experience. Data entry experience with the ability to type a minimum of 40 words per minute.

Preferred: Managed care or health plan experience.

Skills

Required:

• Ability to answer a high volume of calls.
• Knowledge of medical terminology.
• Strong team player, punctual, and excellent attendance record.
• Good understanding of service to the disadvantaged population, seniors, and/or people with chronic conditions or disabilities.
• 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.

Additional Information

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 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