L.A. Care Health Plan
Customer Solution Center Service Representative II
L.A. Care Health Plan, Los Angeles, California, United States, 90079
Customer Solution Center Service Representative II
Job Category: Customer Service
Department: Customer Solution Call Center
Location: Los Angeles, CA, US, 90017
Position Type: Full Time
Requisition ID: 12906
Salary Range:
$50,216.00 (Min.) – $62,770.00 (Mid.) – $75,324.00 (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 (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. Responsibilities include supporting queues and management with projects as needed, acting as back-up support to Call Center Leads, handling inbound and outbound interactions for member eligibility verification, general provider inquiries, claim status, program and administration questions for all lines of business, triaging calls to appropriate units or outside entities, and processing payments for L.A. Care Covered members. All interactions are documented in the system of record.
Duties
Answer incoming calls for all product lines from members, potential members, providers and advocates. Handle and resolve member issues, assist members in connecting with internal units or external parties such as Plan Partners, Primary Care Physician (PCP) offices, pharmacists, etc. Provide essential information regarding access to care, coordination of care, benefits, Evidence of Coverage (EOC), Member Handbook, etc. Assist providers in using the Interactive Voice Response (IVR) web portal and verifying member eligibility. Document all calls via the member database systems (QMEIS) and ensure department compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations.
(60%) Troubleshoot and direct calls to the appropriate departments or outside entities.
(15%) Process payments for L.A. Care Covered members.
(15%) Support robocall and ad-hoc member outreach activities as determined by business need.
(10%) Perform other duties as assigned.
Education Required Education Preferred Experience Required:
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.
Preferred:
Managed care or health plan experience.
Previous Automatic Call Distribution (ACD) experience.
Skills Required:
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.
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.
Licenses/Certifications Required Licenses/Certifications Preferred Required Training Physical Requirements Light
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, but are not 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
Nearest Major Market:
Los Angeles
Job Segment:
Call Center Representative, Customer Service Representative, Call Center, Data Entry, Customer Service, Administrative
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Department: Customer Solution Call Center
Location: Los Angeles, CA, US, 90017
Position Type: Full Time
Requisition ID: 12906
Salary Range:
$50,216.00 (Min.) – $62,770.00 (Mid.) – $75,324.00 (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 (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. Responsibilities include supporting queues and management with projects as needed, acting as back-up support to Call Center Leads, handling inbound and outbound interactions for member eligibility verification, general provider inquiries, claim status, program and administration questions for all lines of business, triaging calls to appropriate units or outside entities, and processing payments for L.A. Care Covered members. All interactions are documented in the system of record.
Duties
Answer incoming calls for all product lines from members, potential members, providers and advocates. Handle and resolve member issues, assist members in connecting with internal units or external parties such as Plan Partners, Primary Care Physician (PCP) offices, pharmacists, etc. Provide essential information regarding access to care, coordination of care, benefits, Evidence of Coverage (EOC), Member Handbook, etc. Assist providers in using the Interactive Voice Response (IVR) web portal and verifying member eligibility. Document all calls via the member database systems (QMEIS) and ensure department compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations.
(60%) Troubleshoot and direct calls to the appropriate departments or outside entities.
(15%) Process payments for L.A. Care Covered members.
(15%) Support robocall and ad-hoc member outreach activities as determined by business need.
(10%) Perform other duties as assigned.
Education Required Education Preferred Experience Required:
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.
Preferred:
Managed care or health plan experience.
Previous Automatic Call Distribution (ACD) experience.
Skills Required:
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.
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.
Licenses/Certifications Required Licenses/Certifications Preferred Required Training Physical Requirements Light
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, but are not 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
Nearest Major Market:
Los Angeles
Job Segment:
Call Center Representative, Customer Service Representative, Call Center, Data Entry, Customer Service, Administrative
#J-18808-Ljbffr