Customer Service Representative (CSR), Sr. (OCC) (Bilingual (Required)
Posted on: June 6, 2021
Department(s): Customer Service
Reports to: Supervisor, OneCare Connect Customer Service
FLSA status: Non-Exempt
Salary Grade: D - $44,000 - $58,000
This position will provide telephonic and in person customer
service to OneCare Connect Cal MediConnect members, facilitating
the direction of each inquiry regarding access to healthcare,
community, and other services. OneCare Connect Customer Service,
Sr. Representatives monitor follow-through on needed care and
follow-up on open issues. Works closely with clinical staff to
assist members in resolving healthcare and psychosocial related
issues. Maintains outreach efforts that includes 45-day follow-up
calls, birthday greeting calls, and other outreach campaigns to
nurture open communication and understanding of the program.
OneCare Connect Customer Service, Sr. Representative may also
perform outreach activities at cultural events/fairs within Orange
County, on occasion, in conjunction with the Community Relations
- Guides members in understanding and accessing the benefits they
are entitled to under Medicare and Medi-Cal, through the OneCare
- Provides members with information to help them distinguish
between Medi-Cal and Medicare benefits/claims processed through the
OneCare Connect program.
- Assists with coordination of member's health care and social
service needs both within and outside the Medical Group and
- Maintains documentation of member cases within the FACETS
- Initiates referrals to both internal and external care
management departments and other department/government or community
- Participates in special events/fairs outside of regularly
scheduled working hours, as needed.
- Participates in departmental phone outreach campaigns on a
- Other projects and duties as assigned.
Knowledge & Abilities:
- Maintain accurate records and documentation.
- Develop rapport, establish, and maintain effective
interpersonal relationships with internal and external contacts at
- Prepare and provide effective orientations and education
- Work with Case Management staff to expedite the resolution of
- Remain knowledgeable of the medical groups and OneCare
Connect's benefit structure.
- Speak, understand, read and/or write in a second language in
addition to English is required for some assignments.
- Communicate clearly and concisely, both verbally and in writing
with individuals from diverse backgrounds.
- Utilize computer and appropriate software (e.g., Microsoft
Office: Word, Outlook, Excel, PowerPoint) and job specific
applications/systems to produce correspondence, charts,
spreadsheets, and/or other information applicable to the position
Experience & Education:
- High school degree or equivalent required.
- 2+ years of experience in a customer/member service or call
center capacity required.
- Bilingual in English and in one of CalOptima's defined
threshold language (Spanish, Vietnamese, Arabic, Farsi, Korean,
Chinese) is required.
- 2+ years Health Maintenance Organization (HMO),
Medi-Cal/Medicaid and health services experience preferred.
- Medicare and Medi-Cal eligibility and benefits preferred.
- Issues that face members with special needs, such as seniors
and persons with disabilities.
- Principles and practices of health care service delivery and
managed care, Medi-Cal/ CalOptima eligibility and benefits.
- Principles and techniques to serve the SPD population in
diverse social and ethnic groups.
EEO Statement: CalOptima is an equal employment opportunity
employer and makes all employment decisions on the basis of merit.
CalOptima wants to have qualified employees in every job position.
CalOptima prohibits unlawful discrimination against any employee,
or applicant for employment, based on race, religion/religious
creed, color, national origin, ancestry, mental or physical
disability, medical condition, genetic information, marital status,
sex, sex stereotype, gender, gender identity, gender expression,
transitioning status, age, sexual orientation, immigration status,
military status as a disabled veteran, or veteran of the Vietnam
era, or any other consideration made unlawful by federal, state, or
local laws. CalOptima also prohibits unlawful discrimination based
on the perception that anyone has any of those characteristics or
is associated with a person who has, or is perceived as having, any
of those characteristics.
ADA/Accommodation Statement: If you are a qualified individual
with a disability or a disabled veteran, you may request a
reasonable accommodation if you are unable or limited in your
ability to access job openings or apply for a job on this site as a
result of your disability. You can request reasonable
accommodations with 72-hour notice by contacting Human Resources
Disability Management at 657-900-1134.
Keywords: CalOptima, Orange , Customer Service Representative (CSR), Sr. (OCC) (Bilingual (Required), Other , Orange, California
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