Customer Solution Center Service Representative II

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 in five health plans, 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 Customer Solution Center Representative II has advanced knowledge of healthcare and various managed care product lines, Medi-Cal, PASC, L.A. Care Covered/Cal Medi-Connect and proficient in medical terminology. This position responsibilities include duties such as: assist supporting queues and Management with projects as needed (e.g. provide informative feedback on desktop procedures, follow-up on member inquiries, CSC Representative shadowing etc.), acting as back-up support to Call Center Supervisors and Leads. This position handles inbound and outbound interactions involving member eligibility verification, general provider inquiries, claim status (pre-payment), general program and administration questions for all lines of business including direct member request for I.D cards and PCP changes, triage of calls to appropriate unit. Processing payments for L.A. Care Covered members, Document all call interactions in system of record.

Duties

Answers incoming calls from members, potential members, and advocates. Handles and resolves member issues or assists members in connecting with internal units or external parties such as Plan Partners, Primary Care Physician (PCP) offices, pharmacists, etc. Provides essential information to members regarding access to care issues, coordination of care issues, benefits, Evidence of Coverage (EOC), Member Handbook, etc. and assist members in using the self-service tools where available and verifying member eligibility. Performs the completion of PCP transfers. Process plan partner changes. Process payments for L.A. Care Covered members. Document all calls in the system of record. (50%)

Answers incoming calls from providers regarding general provider inquiries, claim status (pre-payment), general program and administration questions for all lines of business including direct member request for I.D cards and PCP changes, triage of calls to appropriate unit. Handles and resolves provider issues or assists providers in connecting with internal units. Provides essential information to members regarding access to care issues, coordination of care issues, benefits, Evidence of Coverage (EOC) and assist providers in using the self-service tools where available and verifying member eligibility. Performs the completion of PCP transfers. Process plan partner changes. Handles complex calls as needed coordinates with Member Relations Unit to assist members with complex issues and coordination of care issues within Plan Partners. Assist with new hire shadowing as needed and based on performance metrics. Processing payments for L.A. Care Covered members. Document all call interactions in system of record. (20%)

Assists with the timely contact of members regarding member outreach and retention programs for all lines of business via direct member communication, including welcome calls and meeting all regulatory requirement for Health Risk Assessments for CalMediConnect members and well as Seniors and People with Disabilities (SPD) members. Facilitate member choice assignment and fulfillment of materials in the appropriate language and/or alternative format. This aligned with service level requirements. Ad hoc outreach efforts as determined by business need. (20%)

Perform other duties as assigned. (10%)

Education Required

High School Diploma/or High School Equivalency Certificate

Education Preferred

Experience

Required:
At least 0-1 years customer service telephone experience in a healthcare environment.

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

Ability to answer a high volume of calls; previous ACD experience preferred.

Preferred:
Managed care or health plan experience.

Skills

Required:
Knowledge of medical terminology.

Good understanding of service to the disadvantaged population, seniors and or people with chronic conditions or disabilities.

Must be a quick learner, excellent team player and customer service oriented.

The member services representative will perform various functions including answering calls, conducting outreach activities and performing various data entry functions.

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.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Additional Information

L.A. Care offers a wide range of benefits including

Paid Time Off (PTO)

Tuition Reimbursement

Retirement Plans

Medical, Dental and Vision

Wellness Program

Volunteer Time Off (VTO)

At L.A. Care, we value our team members’ safety. In order to keep our work locations safe, each employee is required to self-screen for symptoms prior to entering any L.A. Care location each day. L.A. Care and all of its staff are required to comply with all state and local masking orders. Therefore, when on-site at any L.A. Care location, employees are expected to wear a mask in areas where physical distancing cannot be managed.