Customer Service Representative I (2730)

Word & Brown Companies•Orange, CA

12d

About The Position

The Customer Service Representative I handles customer calls and communications to resolve issues, provide education and follow-up, and answer questions about California Choice plan administration and procedures. The role serves groups, members, brokers, general agencies, providers, and sales representatives. It requires accurate, courteous service while meeting departmental standards for call quality, call volume, documentation, turnaround time, and work quality. The representative must follow HIPAA and PHI guidelines and maintain regular, punctual attendance, either on-site or remotely.

Requirements

California Life & Health license required; applicants without a license must obtain one within six months of hire.
Excellent verbal and written communication skills, particularly under pressure.
Ability to handle irate customers courteously, patiently, calmly, and positively while maintaining high-quality and high-volume work.
Experience handling high call volumes.
Computer literacy, including Windows, Microsoft Word, Excel, and Outlook; word-processing skills.
Accurate data-entry skills.
Typing speed of at least 55 words per minute.
Ability to work in a fast-paced environment, prioritize deadlines, and handle multiple assignments simultaneously.
Problem-solving skills.
Proficient knowledge of English.
High school diploma or equivalent.
Ability to sit for extended periods, with occasional standing and walking; adequate hearing for phone work; close vision and ability to adjust focus; ability to communicate effectively in English; ability to use a keyboard and other office equipment; and ability to lift up to 30 pounds occasionally.

Nice To Haves

Knowledge of the health insurance industry.
At least two years of customer service experience.
Proficient knowledge of Spanish.
Language Assistance Certification is required every two years if hired as a bilingual representative.

Responsibilities

Apply company policies and procedures as they relate to California Choice plans.
Answer groups’ telephone and email questions about new hires, billing, rates, supplies, and administrative procedures.
Educate employees and dependents by telephone or email about ID cards, administrative procedures, dependent coverage, and address changes.
Follow up on broker calls and emails about problems their groups are experiencing with providers.
Interact daily with brokers, general agents, and sales representatives and answer questions about California Choice processes.
Respond to provider calls to confirm eligibility and benefits.
Verify enrollments and resolve issues with carriers.
Expedite member enrollment processing with carriers when urgent services are needed.
Review and submit group appeal requests.
Review and audit group billing and explain it clearly and accurately to clients.
Document calls in the call tracking system and maintain documentation in applicable databases, including Doc Link and Opportunity.
Work in a paperless environment using the Doc Link system.
Meet department standards for call review quality, daily call volume, documentation, busy time, work quality and quantity, and turnaround times.
Adhere to HIPAA and PHI guidelines.
Maintain regular and punctual attendance, on-site or remotely.
Perform other business tasks or functions as assigned.