Customer Service Rep, Covered California

CalOptima Health Partnership; Orange (CA); On-site; USD 48,000 - 65,000; Full time

Benefits offered by this job

Competitive compensation

Full Office

Comprehensive benefits package

CalPERS pension program

Generous PTO

Tuition Reimbursement

Professional development opportunities

Flexible scheduling

Wellness programs

Job summary

CalOptima Health Partnership in Orange, CA is seeking a Customer Service Rep for Covered California to be the first line of contact for members and providers. You will assist with questions about eligibility, benefits and services, and direct cases to the appropriate teams.

You will engage with colleagues and external partners to ensure compassionate, timely support while contributing to a stronger, more equitable health system.

Qualifications

• High school diploma or equivalent PLUS 6 months of call center experience.
• Experience with Covered California or health insurance marketplace is required.
• Typing speed of 35 WPM is required.

Responsibilities

• Serve as first point of contact for members and providers regarding Covered California questions.
• Assist with eligibility, benefits and covered services inquiries and direct cases to appropriate teams.
• Provide information, resolve inquiries, and document interactions in internal systems.
• Maintain relationships with internal and external partners to ensure timely service delivery.

Skills

Customer service

Call center experience

Typing 35 WPM

Bilingual English/Spanish

Microsoft Office

Education

High school diploma or equivalent

Tools

Microsoft Office

Job description

Join Us in this Amazing Opportunity

The Team You’ll Join

We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.

More About the Opportunity

We are hoping you will join us as a Customer Service Rep, Covered California and help shape the future of healthcare where you’ll be an integral part of our Customer Service team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be Full Office.

• If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.

The Customer Service Rep (Covered CA) will be the first line of contact for CalOptima Health’s members and providers. You’ll assist members and providers with questions and/or complaints related to Covered California regarding eligibility, benefits and covered services. Additionally, you’ll support members by providing information and directing cases to the appropriate operational teams. Together, we are building a stronger, more equitable health system.

Your Contributions To the Team:

• 95% - Customer Support
  • Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
  • Assists the team in carrying out department responsibilities and collaborates with others to support short and long-term goals/priorities for the department.
  • Maintains departmental productivity and quality standards.
  • Responds to and completes all member and provider inquiries or requests during the initial member and provider interaction.
  • Serves as a resource for other team members.
  • Addresses member and provider inquiries, questions and concerns in all areas, including eligibility, enrollment, billing, benefits and covered services in-person or telephonically.
  • Communicates, builds and maintains internal and external relationships by prompt and accurate service delivery.
  • Identifies and communicates challenges that might arise with the use of professional judgment while adhering to departmental policies and procedures.
  • Enter accurate and complete documentation into internal application systems regarding all concerns and/or inquiries from the member and provider interaction.
• 5% - Other
  • Completes other projects and duties as assigned.

Do You Have What the Role Requires?

• High school diploma or equivalent PLUS 6 months of experience in a call center capacity required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
• Experience with Covered California, health insurance exchange/marketplace and/or commercial Individual and Family Plan required.
• Typing speed of 35 words per minute (WPM) required.

You’ll Stand Out More If You Possess the Following:

• Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Russian, Spanish, Vietnamese).
• 6 months of Covered California call center experience.

What the Regulatory Agencies Need You to Possess?

• N/A

Your Knowledge & Abilities to Bring to this Role:

• Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely, both orally and in writing.
• Work a flexible schedule; available to participate in evening and weekend events.
• Organize, be analytical, problem-solve and possess project management skills.
• Work in a fast-paced environment and in an efficient manner.
• Manage multiple projects and identify opportunities for internal and external collaboration.
• Motivate and lead multi-program teams and external committees/coalitions.
• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Your Physical Requirements (With or Without Accommodations):

• Ability to visually read information from computer screens, forms and other printed materials and information.
• Ability to speak (enunciate) clearly in conversation and general communication.
• Hearing ability for verbal communication/conversation/responses via phone, telephone systems, and face-to-face interactions.
• Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
• Lifting and moving objects, patients and/or equipment 10 to 25 pounds

Ways We Are Here For You

• You’ll enjoy competitive compensation for this role.
  • Our current hiring range is: Pay Grade:301 - $47,840 - $64,584 ($23.00 - $31.0500).
    • The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors.
• This position is approved for Full Office(**If the position is Telework, it is eligible in California only**)
• comprehensive benefits package
• CalPERS pension program and additional retirement packages.
• Additional benefits and perks including:
  • A generous PTO program
  • A quality work life balance
  • Various wellness programs
  • Tuition Reimbursement
  • Professional development opportunities
  • Career development opportunities
  • Flexible scheduling
  • And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.

Our Work Environment:

If located at the 500, 505 Building or a remote work location:

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• There are no harmful environmental conditions present for this job.
• The noise level in this work environment is usually moderate.

If located at PACE:

• Work is typically indoors in a clinical setting serving the frail and elderly.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.

If located in the Community: