Call Center Audits and Investigation (A&I) Fraud Agent - Hybrid - West Sacramento, CA

Gainwell Technologies LLC•West Sacramento, CA

11d•$31,200 - $44,500•Hybrid

About The Position

A&I Fraud Agents are responsible for responding to basic to moderately complex fraud telephone calls, handling requests for Medi-Cal and In-Home Supportive Services (IHSS) hotlines complaints of fraud, waste, and abuse and conducting stellar customer service. Your role in our mission: Answers telephone calls using an automated system and responds to basic beneficiary and provider questions and/or forwards call to appropriate personnel. Identify Medi-Cal provider and beneficiary fraud, waste, and abuse, emphasizing fraud prevention in accordance with service level agreements (SLAs). Documents calls in a customer relationship management (CRM) ticketing solution, resolves written provider requests/inquiries and updates provider history with results of inquiry to include proper documentation. Interfaces with team personnel, management, and customers in reference to customer service issues. Conducts outbound calls to providers in response to voicemail inquiries, customer direction or other business needs.

Requirements

High school diploma or G.E.D.
6 months minimum, prefer on more years of customer service or other telephone experience.
Experience working with organizational functions and personnel.
Experience working with fax machines, computer software and telephone technology.
Experience working with and skilled in the use of help desk software.

Nice To Haves

Business and analytical critical thinking skills.
Communication skills both written and oral.
Ability to work independently, follow oral and written directions.
Ability to navigate Microsoft Word, Microsoft Teams, Microsoft Outlook, and internet browsers.

Responsibilities

Answers telephone calls using an automated system and responds to basic beneficiary and provider questions and/or forwards call to appropriate personnel.
Identify Medi-Cal provider and beneficiary fraud, waste, and abuse, emphasizing fraud prevention in accordance with service level agreements (SLAs).
Documents calls in a customer relationship management (CRM) ticketing solution, resolves written provider requests/inquiries and updates provider history with results of inquiry to include proper documentation.
Interfaces with team personnel, management, and customers in reference to customer service issues.
Conducts outbound calls to providers in response to voicemail inquiries, customer direction or other business needs.