Contact Center Representative II

L.A. Care; Los Angeles (CA); Presencial; USD 50 000 - 63 000; Tempo parcial

Vantagens oferecidas por esta oferta de emprego

Paid Time Off (PTO)

Tuition Reimbursement

Retirement Plans

Medical, Dental and Vision

Wellness Program

Resumo da oferta

L.A. Care Health Plan in Los Angeles, CA is seeking a Contact Center Representative II to be the first point of contact for members and providers, handling moderately complex inquiries related to eligibility, benefits, claims, and authorisations.

This role emphasizes accurate information delivery and compassionate member service. The CCR II supports Commercial and Medicare products, with opportunities to work across channels and coordinate with internal teams to ensure seamless healthcare

Qualificações

• At least 2 years of customer service contact centre experience in a healthcare environment.
• Data entry experience with ability to type a minimum of 40 wpm.
• Knowledge of managed care terminology (Commercial/Medicare) is preferred.

Responsabilidades

• Responds to inquiries across all channels related to eligibility, benefits, claims, authorisations, and coordination of care.
• Provides First Call Resolution by accessing internal tools and external portals on the first call.
• Documents all member interactions in L.A. Care’s system of record.
• Triages and directs calls to the appropriate internal teams or external entities for resolution.
• Maintains current knowledge of benefit plans and internal policies to ensure compliant information delivery.

Conhecimentos

Empathy & patience

HIPAA knowledge

Verbal & written communication

Multitasking

Healthcare operations

Microsoft Office

Descrição da oferta de emprego

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Contact Center Representative II

Job Category: Customer Service

Department: Engagement & Experience Contact Center

Location: Los Angeles, CA, US, 90017

Position Type: Part Time

Requisition ID: 13043

Salary Range:$50,216.00(Min.) -$62,770.00(Mid.) - (Max.)

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.
Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

Job Summary

The Contact Center Representative (CCR) II is the first point of contact for members, providers, and stakeholders, delivering complete, accurate and compassionate support on moderately complex issues related to eligibility, benefits, claims, authorisations, Primary Care Physician (PCP) changes, and other service needs ensuring seamless triage across the healthcare journey. The CCR II delivers a high-quality service experience that supports member retention and health outcomes.

The CCR II focuses on all managed care product lines, with an in-depth understanding of Commercial and Medicare products.

Duties

Responds to inquiries across all channels related to eligibility, benefits, claims, authorisations, 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 accessing internal tools and external portals to address the needs of our members and providers effectively on the first call. Supports members and providers with navigation of self-service tools. Resolves moderately complex issues requiring coordination with internal departments. Capture and reconcile premium billing payments, ensuring accurate calculation of member premiums. Initiates Service Authorization Requests (SARs). Documents all member 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, as needed. Maintain current knowledge of benefit plans, regulatory requirements, and internal policies to ensure compliant and accurate information delivery. (80%)

Supports ad-hoc targeted member outreach activities as determined by business need. (10%)

Performs other duties as assigned. (10%)

Experience

Required:

At least 2 years of customer service contact centre experience in a healthcare environment.

Data entry experience with ability to type a minimum of 40 wpm.

Preferred:

Member Services contact centre experience at a Commercial or Medicare Managed Care plan.

Skills

Required:

Ability to answer a high volume of calls while demonstrating a high level of empathy and patience.

Knowledge of managed care terminology, specifically in the commercial and Medicare space.

Familiarity with HIPAA regulations and confidentiality practices.

Strong verbal and written communication skills.

Strong probing, problem-solving and multitasking skills with attention to detail.

Strong understanding of healthcare operations including claims processing and benefits administration.

Proficient in contact centre systems and Microsoft Office.

Preferred:
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.

Physical Requirements

Light

Additional Information

L.A. Care Health Plan’s Contact Centre is open 24 hours a day, 7 days a week, including holidays. Contact Centre work shifts are assigned based on business need and may include, but not be limited to, evenings, weekends and holidays.

Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

L.A. Care offersa wide range of benefits including

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

Nearest Major Market: Los Angeles
Job Segment: Customer Service Representative, Medicare, Claims, Compensation, Data Entry, Customer Service, Healthcare, Insurance, Human Resources, Administrative