Customer Service Representative
Health Plan of San Joaquin/Mountain Valley Health Plan, Modesto, CA, United States
Job Summary
The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
Join our team! We are hiring a Customer Service Representative for our Modesto office. This is a fully onsite position.
Training Schedule Monday to Friday from 8:00 to 4:30 pm
Regular Schedule (After Training) Monday to Friday from 8 am to 5 pm
Responsibilities Under direct supervision, the Customer Service Rep is responsible for responding to and resolving a variety of inquiries, requests and issues from external and internal customers in a call center environment.
Vision Continuously improve the health of our community.
Mission We provide healthcare value and advance wellness through community partnerships.
Essential Functions
Provides information on benefits, eligibility, claims, authorizations and other related items over the phone and in person.
Researches and resolves issues related to claims and authorizations; monitors progress.
Researches and resolves complex eligibility issues; monitors progress.
Creates required documentation, including but not limited to call logs and other tracking systems.
What You Bring – Knowledge, Skills, Abilities and Competencies Required
Produces work that is accurate and complete.
Actively learns through experimentation when tackling new problems, using both successes and failures to learn.
Rebounds from setbacks and adversity when facing difficult situations.
Knows the most effective and efficient process to get things done, with a focus on continuous improvement.
Interpersonal skills – interacts effectively with individuals both inside and outside of HPSJ; relates openly and comfortably with diverse groups of people.
Strong oral and written communication skills, with ability to express self clearly and professionally, and document according to standards.
Strong listening skills, with the ability to accurately receive and understand messages.
Basic conflict resolution skills, with the ability to use tact and diplomacy to diffuse emotional situations.
Ability to work independently and as part of a team.
Demonstrates a commitment to HPSJ’s strategy, vision, mission and values.
Ability to read, understand and apply complex written guidelines, instructions and other materials.
Ability to compare and discern the difference between multiple sets of data or information.
Basic arithmetic skills.
Basic knowledge of contact center systems.
Basic skills in Windows, Word, Excel and Outlook.
Ability to navigate multiple systems and resources simultaneously.
Ability to handle confidential information with appropriate discretion.
Ability to speak and be understood in English.
Proficiency (as defined by HPSJ’s Cultural and Linguistics Program) in one of HPSJ’s threshold languages may be required, depending on business requirements.
Must type 40 WPM.
Must pass Call Center Listening Skill test with a score of 71+.
Preferred
Ability to efficiently and effectively handle calls of heavy volume (50–100 per day), including documentation and resolution.
Knowledge of Medi-Cal programs
Knowledge of Medicare DSNP programs
Knowledge of managed care
Knowledge of medical policy benefits and exclusions
Knowledge of medical terminology
Knowledge of ICD and CPT coding.
Education and Experience Required
High school diploma or general education degree; and
Customer Service experience.
Preferred
Associate’s Degree
Experience in customer service in a health plan, managed care, Medicare DSNP and/or Medi-Cal.
At least one year handling heavy call volume (50–100 calls per day).
Licenses, Certifications None.
Perks – What You Will Get
Competitive salary
Robust and affordable health/dental/vision with choices in providers
Generous paid time off (accrue up to 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays)
CalPERS retirement pension program, automatic employer‑paid retirements contributions, in addition to voluntary defined contribution plan
Two flexible spending accounts (FSAs)
Employer‑Paid Term Life and AD&D Insurance
Employer‑Paid Disability Insurance
Employer‑Paid Life Assistance Program
Health Advocacy
Supplemental medical, legal, identity theft protection
Access to exclusive discount mall
Education and training reimbursement in addition to employer‑paid elective learning courses.
A chance to work for an organization that is mission‑driven – our members and community are at the core of everything we do.
A shorter commute – if you’re commuting from the Central Valley to the Bay Area.
Visibility and variety – you have a chance to work with people at all levels of the organization, and work on diverse projects.
Physical Demands Work may require frequent sitting, standing, and walking, constant repetitive motion, frequent talking and listening, close‑up and distance vision requirements. Some work may require occasional travel based on the responsibilities of the position and business needs and occasional handling materials up to 50 pounds.
Emotional/Psychological Demands Ability to cope with a fast‑paced work environment, working under pressure, dynamic priorities and deadlines, constant decision making, working irregular hours, emotional and sensitive situations.
Work Environment Work may be performed in a remote, hybrid, or onsite setting depending on the requirements of the position and business needs. For roles performed remotely, employees are expected to maintain a secure, distraction‑free workspace, and reliable internet connectivity consistent with company standards.
Equal Employment Opportunity Statement We are an equal opportunity employer, and diversity is one of our core values. We believe that differences including race, ethnicity, gender, sexual orientation, and other characteristics will help us create a strong organization that is sensitive to the needs of those we serve. Employment decisions are made on the basis of qualifications and merit.
HPSJ provides equal employment opportunities to employees and applicants for employment and prohibits discrimination based on color, race, gender (including gender identity and gender expression), religion (including religious dress and grooming practices), marital status, registered domestic partner status, age, national origin (including language use) or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), sex (including pregnancy, childbirth, breastfeeding or related medical condition), genetic information, sexual orientation, military or veteran status, political affiliation or any other characteristic made unlawful by applicable Federal, State or local laws. It also prohibits unlawful discrimination based on the perception that anyone has these characteristics or is associated with anyone who has or is perceived to have these characteristics.
Important Notice This job description is not a contract between HPSJ and the employee performing the job. The duties listed in the job description may be changed at the discretion of HPSJ, and HPSJ may request the employee to perform duties that are not listed on the job description.
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Join our team! We are hiring a Customer Service Representative for our Modesto office. This is a fully onsite position.
Training Schedule Monday to Friday from 8:00 to 4:30 pm
Regular Schedule (After Training) Monday to Friday from 8 am to 5 pm
Responsibilities Under direct supervision, the Customer Service Rep is responsible for responding to and resolving a variety of inquiries, requests and issues from external and internal customers in a call center environment.
Vision Continuously improve the health of our community.
Mission We provide healthcare value and advance wellness through community partnerships.
Essential Functions
Provides information on benefits, eligibility, claims, authorizations and other related items over the phone and in person.
Researches and resolves issues related to claims and authorizations; monitors progress.
Researches and resolves complex eligibility issues; monitors progress.
Creates required documentation, including but not limited to call logs and other tracking systems.
What You Bring – Knowledge, Skills, Abilities and Competencies Required
Produces work that is accurate and complete.
Actively learns through experimentation when tackling new problems, using both successes and failures to learn.
Rebounds from setbacks and adversity when facing difficult situations.
Knows the most effective and efficient process to get things done, with a focus on continuous improvement.
Interpersonal skills – interacts effectively with individuals both inside and outside of HPSJ; relates openly and comfortably with diverse groups of people.
Strong oral and written communication skills, with ability to express self clearly and professionally, and document according to standards.
Strong listening skills, with the ability to accurately receive and understand messages.
Basic conflict resolution skills, with the ability to use tact and diplomacy to diffuse emotional situations.
Ability to work independently and as part of a team.
Demonstrates a commitment to HPSJ’s strategy, vision, mission and values.
Ability to read, understand and apply complex written guidelines, instructions and other materials.
Ability to compare and discern the difference between multiple sets of data or information.
Basic arithmetic skills.
Basic knowledge of contact center systems.
Basic skills in Windows, Word, Excel and Outlook.
Ability to navigate multiple systems and resources simultaneously.
Ability to handle confidential information with appropriate discretion.
Ability to speak and be understood in English.
Proficiency (as defined by HPSJ’s Cultural and Linguistics Program) in one of HPSJ’s threshold languages may be required, depending on business requirements.
Must type 40 WPM.
Must pass Call Center Listening Skill test with a score of 71+.
Preferred
Ability to efficiently and effectively handle calls of heavy volume (50–100 per day), including documentation and resolution.
Knowledge of Medi-Cal programs
Knowledge of Medicare DSNP programs
Knowledge of managed care
Knowledge of medical policy benefits and exclusions
Knowledge of medical terminology
Knowledge of ICD and CPT coding.
Education and Experience Required
High school diploma or general education degree; and
Customer Service experience.
Preferred
Associate’s Degree
Experience in customer service in a health plan, managed care, Medicare DSNP and/or Medi-Cal.
At least one year handling heavy call volume (50–100 calls per day).
Licenses, Certifications None.
Perks – What You Will Get
Competitive salary
Robust and affordable health/dental/vision with choices in providers
Generous paid time off (accrue up to 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays)
CalPERS retirement pension program, automatic employer‑paid retirements contributions, in addition to voluntary defined contribution plan
Two flexible spending accounts (FSAs)
Employer‑Paid Term Life and AD&D Insurance
Employer‑Paid Disability Insurance
Employer‑Paid Life Assistance Program
Health Advocacy
Supplemental medical, legal, identity theft protection
Access to exclusive discount mall
Education and training reimbursement in addition to employer‑paid elective learning courses.
A chance to work for an organization that is mission‑driven – our members and community are at the core of everything we do.
A shorter commute – if you’re commuting from the Central Valley to the Bay Area.
Visibility and variety – you have a chance to work with people at all levels of the organization, and work on diverse projects.
Physical Demands Work may require frequent sitting, standing, and walking, constant repetitive motion, frequent talking and listening, close‑up and distance vision requirements. Some work may require occasional travel based on the responsibilities of the position and business needs and occasional handling materials up to 50 pounds.
Emotional/Psychological Demands Ability to cope with a fast‑paced work environment, working under pressure, dynamic priorities and deadlines, constant decision making, working irregular hours, emotional and sensitive situations.
Work Environment Work may be performed in a remote, hybrid, or onsite setting depending on the requirements of the position and business needs. For roles performed remotely, employees are expected to maintain a secure, distraction‑free workspace, and reliable internet connectivity consistent with company standards.
Equal Employment Opportunity Statement We are an equal opportunity employer, and diversity is one of our core values. We believe that differences including race, ethnicity, gender, sexual orientation, and other characteristics will help us create a strong organization that is sensitive to the needs of those we serve. Employment decisions are made on the basis of qualifications and merit.
HPSJ provides equal employment opportunities to employees and applicants for employment and prohibits discrimination based on color, race, gender (including gender identity and gender expression), religion (including religious dress and grooming practices), marital status, registered domestic partner status, age, national origin (including language use) or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), sex (including pregnancy, childbirth, breastfeeding or related medical condition), genetic information, sexual orientation, military or veteran status, political affiliation or any other characteristic made unlawful by applicable Federal, State or local laws. It also prohibits unlawful discrimination based on the perception that anyone has these characteristics or is associated with anyone who has or is perceived to have these characteristics.
Important Notice This job description is not a contract between HPSJ and the employee performing the job. The duties listed in the job description may be changed at the discretion of HPSJ, and HPSJ may request the employee to perform duties that are not listed on the job description.
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