Customer Service Rep Sr - Orange - Sunshine Enterprise Inc

    Sunshine Enterprise Inc
    Sunshine Enterprise Inc Orange

    7 hours ago

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    Description

    Job Description

    We are seeking a highly skilled Customer Service Representative Senior to join our team at Sunshine Enterprise USA LLC.

    The ideal candidate will be communicative, organized, and responsible with excellent problem-solving skills. They will address member inquiries, questions, and concerns in all areas, including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care.

    Responsibilities:

    • 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.
    • Accurate, complete, and correct documentation into Facets regarding all issues, inquires, complaints, and grievances.
    • 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 requests 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 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.

    Qualifications:

    • 2 years of Health Maintenance Organization (HMO), Medi-Cal/Medicaid, and health services experience preferred.
    • 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 is also qualifying.
    • Bilingual in English and in Arabic, Farsi, Chinese, Korean, Spanish, or Vietnamese required.

    Necessary Attributes:

    • Establish and maintain effective working relationships with CalOptima Health's 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 CalOptima 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.

    Benefits:

    • Competitive pay & weekly paychecks.
    • Health, dental, vision, and life insurance.
    • 401(k) savings plan.
    • Awards and recognition programs.
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