Customer Service Representative

Health Plan of San Joaquin/Mountain Valley Health Plan; Modesto (CA); On-site; USD 36,000 - 54,000; Full time

Benefits offered by this job

Competitive salary

Health/dental/vision insurance

Paid time off (PTO)

Job summary

Health Plan of San Joaquin/Mountain Valley Health Plan is seeking a Customer Service Representative for the Modesto office. This fully onsite role handles member inquiries, resolves issues, and documents interactions in a busy call center.

Under supervision, you will assist with benefits, eligibility, and claims questions, navigating multiple systems with accuracy and discretion to support our mission and member care.

Qualifications

• Produces accurate and complete work.
• Strong written and verbal communication; documents to standards.
• Ability to learn quickly and adapt to new processes.
• Able to handle confidential information with discretion.

Responsibilities

• Respond to and resolve inquiries from external and internal customers in a call center environment.
• Research and resolve issues related to benefits, eligibility, claims, and authorizations; monitor progress.
• Create documentation such as call logs and tracking records.
• Maintain accurate data across multiple systems.

Skills

Customer service

Call center

Data entry

English proficiency

Education

High school diploma

Tools

Windows

Excel

Outlook

CRM systems

Job description

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

Join our team! We are hiring a Customer Service Representative for our Modesto office. This is a fully onsite position.

Training Schedule: Monday to Friday from 8:00 to 4:30

After Training: Monday to Friday from 8:00 to 5

At this time, the Health Plan does not sponsor visa. Candidates must have legal and valid work authorization, Green Card, or U.S. citizenship.

What You Will Be Doing:

Under direct supervision, the Customer Service Rep is responsible for responding to and resolving a variety of inquiries, requests and issues from external and internal customers in a call center environment.

Our Vision:

Continuously improve the health of our community.

Our Mission:

We provide healthcare value and advance wellness through community partnerships.

Essential Functions:

• Provides information on benefits, eligibility, claims, authorizations and other related items over the phone and in person.
• Researches and resolves issues related to claims and authorizations; monitors progress.
• Researches and resolves complex eligibility issues; monitors progress.
• Creates required documentation, including but not limited to call logs and other tracking systems.

What You Bring:

Knowledge, Skills, Abilities and Competencies

Required

• Produces work that is accurate and complete.
• Actively learns through experimentation when tackling new problems, using both successes and failures to learn.
• Rebounds from setbacks and adversity when facing difficult situations.
• Knows the most effective and efficient process to get things done, with a focus on continuous improvement.
• Interpersonal skills - interacts effectively with individuals both inside and outside of HPSJ; relates openly and comfortably with diverse groups of people.
• Strong oral and written communication skills, with ability to express self clearly and professionally, and document according to standards.
• Strong listening skills, with the ability to accurately receive and understand messages.
• Basic conflict resolution skills, with the ability to use tact and diplomacy to diffuse emotional situations.
• Ability to work independently and as part of a team.
• Demonstrates a commitment to HPSJ’s strategy, vision, mission and values.
• Ability to read, understand and apply complex written guidelines, instructions and other materials.
• Ability to compare and discern the difference between multiple sets of data or information.
• Basic arithmetic skills.
• Basic knowledge of contact center systems.
• Basic skills in Windows, Word, Excel and Outlook.
• Ability to navigate multiple systems and resources simultaneously.
• Ability to handle confidential information with appropriate discretion.
• Ability to speak and be understood in English.
• Proficiency (as defined by HPSJ’s Cultural and Linguistics Program) in one of HPSJ’s threshold languages may be required, depending on business requirements.
• Must type 40 WPM.
• Must pass Call Center Listening Skill test with a score of 71+.

Preferred

• Ability to efficiently and effectively handle calls of heavy volume ( 50-100 per day), including documentation and resolution.
• Knowledge of Medi-Cal programs
• Knowledge of Medicare DSNP programs
• Knowledge of managed care
• Knowledge of medical policy benefits and exclusions
• Knowledge of medical terminology
• Knowledge of ICD and CPT coding.

What You Have:

Education and Experience

Required

• High school diploma or general education degree; and
• Customer Service experience.

Preferred

• Associate’s Degree
• Experience in customer service in a health plan, managed care, Medicare DSNP and/or Medi-Cal.
• At least one year handling heavy call volume (50-100 calls per day).

Licenses, Certifications

None.

HPSJ Perks:

What You Will Get:

• Competitive salary
• Robust and affordable health/dental/vision with choices in providers
• Generous paid time off (accrue up to 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays)
• CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution plan
• Two flexible spending accounts (FSAs)
• Employer-Paid Term Life and AD&D Insurance
• Employer-Paid Disability Insurance
• Employer-Paid Life Assistance Program
• Health Advocacy
• Supplemental medical, legal, identity theft protection
• Access to exclusive discount mall
• Education and training reimbursement in addition to employer-paid elective learning courses.
• A chance to work for an organization that is mission-driven - our members and community are at the core of everything we do.
• A shorter commute - if you're commuting from the Central Valley to the Bay Area.
• Visibility and variety - you have a chance to work with people at all levels of the organization, and work on diverse projects.

Physical Demands

Frequent sitting, standing and walking, constant repetitive motion, frequent talking and listening, occasional handling of materials up to 50 lbs., closeup and distance vision requirements, occasional travel.

We are an equal opportunity employer and diversity is one of our core values. We believe that differences including race, ethnicity, gender, sexual orientation, and other characteristics, will help us create a strong organization that is sensitive to the needs of those we serve. Employment decisions are made on the basis of qualifications and merit.

HPSJ provides equal employment opportunities to employees and applicants for employment and prohibits discrimination based on color, race, gender (including gender identity and gender expression), religion (including religious dress and grooming practices), marital status, registered domestic partner status, age, national origin (including language use) or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), sex (including pregnancy, childbirth, breastfeeding or related medical condition), genetic information, sexual orientation, military or veteran status, political affiliation or any other characteristic made unlawful by applicable Federal, State or local laws. It also prohibits unlawful discrimination based on the perception that anyone has these characteristics or is associated with anyone who has or is perceived to have these characteristics.

Important Notice : This job description is not a contract between HPSJ and the employee performing the job. The duties listed in the job description may be changed at the discretion of HPSJ, and HPSJ may request the employee to perform duties that are not listed on the job description.