Bilingual Customer Service Representative

Location: Orange, CA
Date Posted: 04-06-2018
Customer Service Representative (Outbound Calls) - Managed Care
Orange, CA
*** This is a Full-Time, Benefits Available, CONTRACT position expected to last 5-6 months or longer ***
Your Job Summary:
Customer Service Representatives are the front-lines of providing excellence in customer care to both internal and external clients.  The position has direct contact with provider facilities and medical staff throughout the region.  The customer service representative acts as an advocate for customers (members, providers, facilities, etc.) by providing guidance, interpretation, and education on benefit coverage levels, claims payment, and various program inquires. The Customer Service Representative works hard to build trusted relationships with members across their health care life cycle.  This includes assisting in plan selection and enrollment, educating members about management of their health and well-being, helping members to maximize health plan benefits and personal health care dollars and owning customer service inquiries through to resolution.

Your Background: 
Requires an education level of at least a high school diploma or GED.
Around 2 years customer service experience with at least 1 year experience in an office setting, call center setting, or phone support role.
Healthcare experience is required, including basic familiarity with medical terminology.
Ability to multi-task duties as well as the ability to understand multiple products and multiple levels of benefits within each product.
Knowledge of health care delivery system, Medicaid/Medicare and related state programs is a significant plus.
Computer skills to include Microsoft Word, Excel and basic data entry, including the ability to learn new and complex computer system applications.
Must test at a minimum of 35 wpm typing with a high level of accuracy.
Ability to work regularly scheduled shifts within hours of operation.

Your Duties:
  • Place outbound calls to providers as directed, in order to process provider information and answer provider questions (i.e. benefit and eligibility, billing and payments, authorizations for treatment and explanation of benefits)
  • Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems
  • Investigate inquiries, follow up on them, and document actions required to service inquiry
  • Assist customers in navigating relevant websites and encourage and reassure them to become self-sufficient
  • Own problem through to resolution on behalf of the customer in real time or through comprehensive and timely follow-up with the member 
  • Research complex issues across multiple databases and work with support resources to resolve customer issues and/or partner with others to resolve escalated issues 
  • Provide education and status on previously submitted pre-authorizations or pre-determination requests
  • Meet the performance goals established for the position in the areas of: efficiency, call quality, caller satisfaction, first call resolution and attendance 

CareNational Healthcare Services
480.478.1635 (CALL – TEXT – FAX)
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