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Customer Service Representative Sr.

Company: Sunshine Enterprise USA LLC
Location: Orange
Posted on: April 3, 2024

Job Description:

Company Overview: Sunshine Enterprise is an industry-leading Staffing and Recruitment Firm. Our clients are fortune 500 companies, high growth start-up companies, government, and private equity firms, and lead professional services firms. As a leading force in the business landscape, we take pride in bringing together great people and great organizations by fostering a work environment that values creativity, diversity, and growth. If you're ready to embark on a rewarding career journey with a company that prioritizes its employees, explore our current job opportunities below. Job SummaryThe Customer Service Representative Sr is the first line of contact for members and providers and will assist them with questions related to the Medi-Cal programs for Orange County. The incumbent resolves member inquiries and complaints fairly and effectively. The incumbent provides information regarding eligibility, enrollment, benefits and services to eligible members and providers. Position Responsibilities

  • Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
  • Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
  • Addresses member inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care.
  • Verifies member eligibility, claim and authorization status for providers.
  • Responsible for thorough follow-up and completion of all member and provider inquires or requests.
  • Responsible for accurate, complete, and correct documentation into Facets regarding all issues, inquires, complaints and grievances.
  • Functions efficiently and productively in a high-volume call center.
  • Maintains departmental productivity and quality standards.
  • Provides follow-up assistance as needed.
  • Routes escalated calls to the appropriate Member Liaison Specialist, Supervisor or Call Center Manager.
  • Adheres to departmental policies and procedures.
  • Processes all member transportation request within one business day of receipt and coordinating all aspects of the process with the clinic, provider, and member as appropriate or necessary.
  • Assists members with Member Web Portal registration and technical support.
  • Interacts face-to-face with members by assisting with front desk coverage.
  • Serves as a backup for Customer Service Leads, as needed.
  • Handles and resolves escalated issues.
  • Competes other projects and duties as assigned. Possesses the Ability To:
    • Establish and maintain effective working relationships with leadership and staff.
    • Function efficiently and productively in a high-volume call center.
    • Learn procedures and regulations governing member eligibility and the terminology and documents used while remaining knowledgeable of Health/Medi-Cal benefits and procedures.
    • Hear and speak well enough to converse on the phone and in person.
    • Understand and follow oral and written directions.
    • Speak, understand, read and/or write a second language in addition to English may be required for some assignments.
    • Communicate clearly and concisely, both orally and in writing.
    • Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems (e.g., Facets) to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Experience & Education
      • High School diploma or equivalent required.
        • 2 years of experience in a customer/member service or call center capacity required.
        • An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.
        • Bilingual in English and in one of defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese) required. Preferred Qualifications
          • 2 years of Health Maintenance Organization (HMO), Medi-Cal/Medicaid and health services experience preferred. Knowledge of:
            • Principles and practices of managed health care, health care systems, and medical terminology.
            • Principles and techniques for handling customer service issues.
            • Personal computers, keyboarding, and appropriate software to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
            • Customer service principles and practices. SUNSHINE ENTERPRISE USA LLC is an Equal Opportunity Employer and does not discriminate on the basis of race or ethnicity, religion, sex, national origin, age, veteran disability or genetic information or any other reason prohibited by law in employment.Compensation details: 21.15-26.83 Hourly WagePI2a83501fa3ac-31181-33981619

Keywords: Sunshine Enterprise USA LLC, Orange , Customer Service Representative Sr., Other , Orange, California

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