Customer Service Representative
CalOptima, Orange, CA, United States
Customer Service Representative
CalOptima
Position Overview We invite you to join our CS‑Medi‑Cal Call Center as a Customer Service Representative. You will be the first line of contact for CalOptima Health members and providers in Orange County, providing information about eligibility, enrollment, benefits, and services.
Responsibilities
80% – Program Support: Participate in a mission‑driven culture focused on customer service; maintain departmental productivity and quality standards; complete member and provider inquiries during the original interaction; serve as a resource for team members.
15% – Administrative Support: Assist team in department responsibilities; address inquiries about eligibility, enrollment, claims, authorizations, benefit interpretation, and referrals; enter accurate documentation into internal systems; communicate with internal and external stakeholders; identify and communicate challenges while adhering to policies.
5% – Other: Complete additional projects and duties as assigned.
Qualifications
High School diploma or equivalent plus 6 months of call‑center experience, or an equivalent combination of education and experience.
Typing speed of 35 words per minute.
Preferred Qualifications
6 months of Medi‑Cal/Medicaid or health‑services experience.
Knowledge & Abilities
Develop rapport and maintain effective working relationships with staff and external contacts.
Work independently and exercise sound judgment.
Communicate clearly and concisely, orally and in writing.
Work a flexible schedule; available for evening and weekend events.
Organize, analyze, solve problems, and possess project‑management skills.
Work efficiently in a fast‑paced environment.
Manage multiple projects and identify collaboration opportunities.
Motivate and lead multi‑program teams and external committees/coalitions.
Utilize computer and appropriate software (e.g., Microsoft Office) and job‑specific applications.
Physical Requirements
Visual reading of screens, documents, and printed materials.
Clear oral communication.
Hearing ability for verbal communication.
Manual dexterity for typing, standing, reaching, bending, kneeling, and prolonged sitting.
Lift and move objects 10–25 pounds.
Benefits
Competitive compensation: Pay Grade 301 – $47,840 – $64,584 ($23.00 – $31.05 per hour).
Full office work option (telework eligible only in California).
CalPERS pension program and additional retirement packages.
Generous PTO program.
Quality work‑life balance and flexible scheduling.
Various wellness programs, tuition reimbursement, and professional development opportunities.
Career development opportunities.
Direct impact on healthcare access for thousands of individuals and families.
Work Environment Typical indoor, sedentary work with variable hours and occasional travel. Noise level moderate. Hazardous conditions do not apply for office locations.
Equal Employment Opportunity & Reasonable Accommodation CalOptima Health is an equal‑opportunity employer. We do not discriminate based on age, race, color, religion, national origin, disability, or any other protected characteristic.Qualified individuals with a disability or a disabled veteran may request reasonable accommodation at (714) 246‑8400.
EEO Statement CalOptima Health complies with federal, state, and local equal‑employment‑opportunity laws. We prohibit discrimination based on race, color, religion, national origin, disability, pregnancy, age, sexual orientation, gender identity, or sexual preference. We are committed to a diverse, inclusive workplace.
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CalOptima
Position Overview We invite you to join our CS‑Medi‑Cal Call Center as a Customer Service Representative. You will be the first line of contact for CalOptima Health members and providers in Orange County, providing information about eligibility, enrollment, benefits, and services.
Responsibilities
80% – Program Support: Participate in a mission‑driven culture focused on customer service; maintain departmental productivity and quality standards; complete member and provider inquiries during the original interaction; serve as a resource for team members.
15% – Administrative Support: Assist team in department responsibilities; address inquiries about eligibility, enrollment, claims, authorizations, benefit interpretation, and referrals; enter accurate documentation into internal systems; communicate with internal and external stakeholders; identify and communicate challenges while adhering to policies.
5% – Other: Complete additional projects and duties as assigned.
Qualifications
High School diploma or equivalent plus 6 months of call‑center experience, or an equivalent combination of education and experience.
Typing speed of 35 words per minute.
Preferred Qualifications
6 months of Medi‑Cal/Medicaid or health‑services experience.
Knowledge & Abilities
Develop rapport and maintain effective working relationships with staff and external contacts.
Work independently and exercise sound judgment.
Communicate clearly and concisely, orally and in writing.
Work a flexible schedule; available for evening and weekend events.
Organize, analyze, solve problems, and possess project‑management skills.
Work efficiently in a fast‑paced environment.
Manage multiple projects and identify collaboration opportunities.
Motivate and lead multi‑program teams and external committees/coalitions.
Utilize computer and appropriate software (e.g., Microsoft Office) and job‑specific applications.
Physical Requirements
Visual reading of screens, documents, and printed materials.
Clear oral communication.
Hearing ability for verbal communication.
Manual dexterity for typing, standing, reaching, bending, kneeling, and prolonged sitting.
Lift and move objects 10–25 pounds.
Benefits
Competitive compensation: Pay Grade 301 – $47,840 – $64,584 ($23.00 – $31.05 per hour).
Full office work option (telework eligible only in California).
CalPERS pension program and additional retirement packages.
Generous PTO program.
Quality work‑life balance and flexible scheduling.
Various wellness programs, tuition reimbursement, and professional development opportunities.
Career development opportunities.
Direct impact on healthcare access for thousands of individuals and families.
Work Environment Typical indoor, sedentary work with variable hours and occasional travel. Noise level moderate. Hazardous conditions do not apply for office locations.
Equal Employment Opportunity & Reasonable Accommodation CalOptima Health is an equal‑opportunity employer. We do not discriminate based on age, race, color, religion, national origin, disability, or any other protected characteristic.Qualified individuals with a disability or a disabled veteran may request reasonable accommodation at (714) 246‑8400.
EEO Statement CalOptima Health complies with federal, state, and local equal‑employment‑opportunity laws. We prohibit discrimination based on race, color, religion, national origin, disability, pregnancy, age, sexual orientation, gender identity, or sexual preference. We are committed to a diverse, inclusive workplace.
#J-18808-Ljbffr