Customer Service Representative - Aspire Health

Community Hospital of the Monterey Peninsula; Monterey (CA); Presencial; USD 42.000 - 54.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Competitive benefit package

Descripción de la vacante

Aspire Health Plan in Monterey, CA is seeking a Customer Service Representative I to be the friendly front line for members, providers, and clients. You will handle inbound calls, emails, and occasional in-person inquiries about eligibility, benefits, and claims, delivering compassionate and accurate responses.

Ideal candidates have an associates degree or equivalent experience, 1–3 years in customer service, and bilingual Spanish/English is a plus.

Formación

• Associates degree, or applicable professional experience, required.
• Minimum 1 to 3 years experience in a customer service, hospitality, or call center.

Responsabilidades

• Serve as a primary point of contact for members, providers, and clients via phone, email, and occasional in‑person interactions
• Assist with questions related to eligibility, benefits, claims status, prior authorization requirements, and appeals
• Provide accurate, timely, and compassionate responses to all customer inquiries
• Proactively educate members and providers based on their specific needs and inquiries, helping them better understand available benefits and next steps
• Thoroughly document all communications and actions in the appropriate system of record
• Research issues and work diligently to bring each inquiry to resolution within established timeframes
• Coordinate member appeals and grievances in collaboration with appropriate internal teams
• Provide support and coverage for interdepartmental staff as needed to ensure continuity of service
• Perform other duties and responsibilities as assigned

Conocimientos

Communication skills

Active listening

Problem solving

Customer service

Educación

Associate degree

Descripción del empleo

Welcome to Montage Health's application process! Job Description: The Customer Service Representative I is the friendly, knowledgeable front line for our local Medicare Advantage health plan members and healthcare partners. In this role, you'll handle inbound calls and inquiries related to eligibility, benefits, and claims-while serving as a trusted advocate for the people who live, work, and age in the same communities we do. Our members aren't just voices on the phone—they're our neighbors, friends, and family members. That's why this role is so critical. We're looking for someone who genuinely enjoys helping people of all ages, brings patience and empathy to every conversation, and takes pride in delivering support that feels personal, respectful, and meaningful. We're looking for naturally curious, solution-oriented problem solvers who can balance compassion with professionalism in a fast-paced environment.

Responsibilities

• Serve as a primary point of contact for members, providers, and clients via phone, email, and occasional in‑person interactions
• Assist with questions related to eligibility, benefits, claims status, prior authorization requirements, and appeals
• Provide accurate, timely, and compassionate responses to all customer inquiries
• Proactively educate members and providers based on their specific needs and inquiries, helping them better understand available benefits and next steps
• Thoroughly document all communications and actions in the appropriate system of record
• Research issues and work diligently to bring each inquiry to resolution within established timeframes
• Coordinate member appeals and grievances in collaboration with appropriate internal teams
• Provide support and coverage for interdepartmental staff as needed to ensure continuity of service
• Perform other duties and responsibilities as assigned

Position Requirements

Excellent verbal and written communication skills, including active listening.Minimum three years' experience in customer service, call center, or similar.Service-oriented; Ability to resolve customer complaints and issues while maintaining a professional and calm demeanor.Ability to operate spreadsheet, word processing programs and computer equipment required to fulfill position responsibilities. Exceptional diplomacy skills to effectively resolve issues under sometimes tense and stressful circumstances. Excellent phone mannerAbility to use sound judgement, identify next steps to be taken, and develop appropriate solutions.Bilingual Spanish/English desired.

Competencies

• Accountability and Dependability : Assumes responsibility for accomplishing duties in an effective and timely manner.-
• Integrity: Consistently honors commitments and takes responsibility for actions and words.-
• Software and Computer Skills: Proficient in the use of Microsoft Office Suite, Highly skilled at using the Internet. Must learns effectively with computer-based and/or online training.-
• Flexibility: Demonstrates adaptability and openness to alternative solutions and flexibility when interacting with others, understanding their attitudes, needs, interests, and perspectives.-
• Inclusiveness: The ability to network and partner with all internal and external stakeholders including broad and diverse representation of private/public and traditional/non-traditional community organizations.

Skills and Education

Associates degree, or applicable professional experience, required. Minimum 1 to 3 years experience in a customer service, hospitality, or call center.

Benefits

• Competitive benefit package

Salary

Commensurate with experience Aspire Health Plan is an equal opportunity employer.

Assigned Work Hours

M-F , 8:15 - 4:45

Position Type

Regular