Contact Center Representative I

L.A. Care Health Plan • Los Angeles, CA

4d • $45,760 - $47,823 • Onsite

About The Position

The Contact Center Representative (CCR) I is the first point of contact for members, providers, and stakeholders, delivering complete, accurate and compassionate support on eligibility, benefits, claims, authorizations, Primary Care Physician (PCP) changes, and other service needs ensuring seamless triage across the healthcare journey. The CCR I primarily supports L.A. Care’s Medi-Cal and Personal Assistance Services Council (PASC) managed care product lines. This support is provided across all communication channels (inbound, outbound, chat, text, email).

Requirements

• At least 1 year of customer service contact center 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 while demonstrating a high level of empathy and patience.
• Knowledge of managed care terminology.
• Familiarity with HIPAA regulations and confidentiality practices.
• Strong verbal and written communication skills.
• Strong probing, problem-solving and multitasking skills.
• Ability to work independently and as part of a team.

Nice To Haves

• Member Services contact center experience in a Managed Care plan.
• 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.

Responsibilities

• Responds to inquiries across all channels related to eligibility, benefits, claims, authorizations, and coordination of care.
• Assists members with navigating their healthcare journey, including understanding their eligibility and benefits, Evidence of Coverage (EOC) and Member Handbook.
• Provides First Call Resolution (FCR) by addressing the needs of members and providers effectively on the first call.
• Supports members and providers with navigation of self-service tools.
• Documents all interactions in L.A. Care’s system of record.
• Ensures compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations and protects member privacy.
• Triages and directs calls to the appropriate internal teams or external entities for resolution.
• Supports ad-hoc targeted member outreach activities as determined by business need.
• Performs other duties as assigned.

Benefits

• Paid Time Off (PTO)
• Tuition Reimbursement
• Retirement Plans
• Medical, Dental and Vision
• Wellness Program
• Volunteer Time Off (VTO)

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED