Customer Service Representative (Bilingual)

---

Job description

Customer Service Representative Sr. (Bilingual)

Company Overview: Our client is a leading healthcare located in Orange, CA, seeking a senior customer service representative, performing as a point of contact for questions and/or complaints related to plan services.

Position Summary: The ideal candidate shall have minimum of two years of customer/member service experience with at least 1 year of call center capacity.

Position Responsibilities

• 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.
• Addresses member and provider inquiries, questions and concerns in all areas, including eligibility, enrollment, claims or authorization status, benefit interpretation and referrals/authorizations for medical care in-person or telephonically.
• Serves as a senior resource for other team members (i.e., solves complex challenges, answers uncommon questions and shares complex processes and procedures).
• Supports in the coordination of member's health care and social service needs both within and outside the medical group.
• Enters accurate and complete documentation into internal application systems regarding all concerns and/or inquiries from the member and provider interaction.
• Initiates referrals to both internal and external care management departments and other department/government or community agencies.
• Maintains departmental productivity and quality standards.
• Follows through on and completes all member and provider inquiries or requests during the original member and provider interaction. Provides additional follow-up assistance as needed.
• Completes other duties or projects as assigned.

Experience & Education

• High School diploma or equivalent required.
• Typing speed of 35 words per minute (WPM) required.
• 2 years of claims experience required.
• 1 year of call center experience with high call volumes or customer service experience analyzing and solving provider claims problems required.
• 1 year of HMO, Medi-Cal/Medicaid and healthcare/managed care experience strongly preferred.
• Bilingual in English and in one of the languages (Arabic, Chinese, Farsi, Korean, Spanish, or Vietnamese) required.
• An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.

Necessary Attributes:

• Develop rapport and establish and maintain effective working relationships with 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
• 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 telephone, 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

Please see HR for information on physical demands and work environment of this job.

Sunshine Enterprise USA is an "Equal Opportunity Employer-Minorities, Females, Veterans and Disabled Persons"

Compensation details: 25-30 Hourly Wage

PI0c370d6c13ad-4400

<!– job description page –>