Customer Service Rep, Covered California

CalOptima

Orange, CAFresher57m agovia LinkedIn

Mission-driven, community-based organization serving member health with excellence and dignity.
Integral part of the Customer Service team, striving for excellence in member health service.
Collaboration with providers, community partners, and local stakeholders.
This position is approved for Full Office.
If telework is approved, work must be within the State of California.
If Partial Telework, a minimum of two (2) days per week is required at the Main Office in Orange, CA.

First line of contact for CalOptima Health's members and providers.
Assist members and providers with questions and/or complaints related to Covered California regarding eligibility, benefits, and covered services.
Support members by providing information and directing cases to appropriate operational teams.
Participate in a mission-driven culture of high-quality performance with a member focus on customer service, consistency, dignity, and accountability.
Assist the team in carrying out department responsibilities and collaborate to support short and long-term goals/priorities.
Maintain departmental productivity and quality standards.
Respond to and complete all member and provider inquiries or requests during the initial interaction.
Serve as a resource for other team members.
Address member and provider inquiries, questions, and concerns in all areas, including eligibility, enrollment, billing, benefits, and covered services, in-person or telephonically.
Communicate, build, and maintain internal and external relationships by prompt and accurate service delivery.
Identify and communicate challenges with professional judgment while adhering to departmental policies and procedures.
Enter accurate and complete documentation into internal application systems regarding all concerns and/or inquiries.
Complete other projects and duties as assigned.

High school diploma or equivalent.
6 months of experience in a call center capacity.
Experience with Covered California, health insurance exchange/marketplace, and/or commercial Individual and Family Plan.
Typing speed of 35 words per minute (WPM).
Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job-specific applications/systems.

Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Russian, Spanish, Vietnamese).
6 months of Covered California call center experience.

Develop rapport and establish/maintain effective working relationships with leadership, staff, and external contacts at all levels and with diverse backgrounds.
Work independently and exercise sound judgment.
Communicate clearly and concisely, both orally and in writing.
Work a flexible schedule; available to participate in evening and weekend events.
Organize, be analytical, problem-solve, and possess project management skills.
Work in a fast-paced environment efficiently.
Manage multiple projects and identify opportunities for internal and external collaboration.
Motivate and lead multi-program teams and external committees/coalitions.

Ability to visually read information from computer screens, forms, and other printed materials.
Ability to speak clearly in conversation and general communication.
Hearing ability for verbal communication via telephone and face-to-face interactions.
Manual dexterity for typing, writing, standing, reaching, flexibility, body movement for bending, crouching, walking, kneeling, and prolonged sitting.
Lifting and moving objects, patients, and/or equipment 10 to 25 pounds.

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