Customer Solution Center Service Representative II

L.A. Care Health Plan

Los Angeles,CA

11/1/2019

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 in five health plans, 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 Representative II has proven intermediate and proficient knowledge of healthcare and various product lines (e.g. Medi-Cal and PASC) and medical terminology. Responsibilities include assisting in supporting queues and management. This position provides informative feedback on desktop procedures and follow-up as needed to provide one-call resolution. This position handles first level calls and triages escalated calls involving member eligibility verification, general program and administration questions, knowledge of at least one product or call skillset. Direct member request for I.D cards and PCP changes, triage of calls to appropriate unit. System use of Cisco, NICE, QMEIS and MEIS.

Duties

Answers incoming calls from members, potential members, providers, and advocates. Handles and resolves member issues or 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. and assist providers in using the Interactive Voice Response (IVR), web portals, and verifying member eligibility. Document all calls in the system of record Performs the completion of PCP transfers. Process plan partner changes. (50%)

Verifies eligibility for Plan Partners, Providers and Members. Assists Management with projects as needed; assist with new hire shadowing. Works with Member Relations Specialist to assist members with complex issues and coordination of care issues within Plan Partners. Trouble shoots and directs calls to the appropriate departments. Handles complex call center calls. (30%)

Participate in Quality Scorecard Training and implement recommendations for improvement based on scorecard results. Check call center voicemail box as needed. (10%)

Performs other duties as assigned. (10%)

Education Required High School Diploma/or High School Equivalency Certificate Education Preferred Experience


Required:
At least 0-6 months of customer service telephone experience in a healthcare environment.

Data entry experience with ability to type a minimum of 40 words per minute.

Ability to answer a high volume of calls.

Preferred:
Previous ACD experience.

Managed care or health plan 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.

The member services representative will perform various functions including answering calls, conducting outreach activities and performing various data entry functions.

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 Additional Information

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)

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