Sr Customer Service Representative

Sr. Customer Service Representative Temp

At Sunshine Enterprise USA were not just a company; were a community of dedicated professionals committed to excellence and innovation. As a leading force in the business landscape we take pride in bringing together great people and great organizations by fostering a work environment that values creativity diversity and growth. If youre ready to embark on a rewarding career journey with a company that prioritizes its employees explore our current job opportunities below.

Job Title: Sr. Customer Service Representative (Member and Provider Services)
Location: Orange California
Salary: $21.15 $26.83
Job Type: Contract (FullTime)
Duration: 6 months (with the possibility of extension or consideration for permanent employment)

Job Summary

The Customer Service Representative Sr is the first line of contact for the members and providers and will assist them with questions related to the MediCal programs for Orange County. The incumbent resolves member inquiries and complaints fairly and effectively. The incumbent provides information regarding eligibility enrollment benefits and services to eligible members and providers.

Position Responsibilities

• Participates in a missiondriven culture of highquality 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 longterm goals/priorities for the department.
  
• Addresses member inquiries questions and concerns in all areas including enrollment claims benefit interpretation and referrals/authorizations for medical care.
  
• Verifies member eligibility claim and authorization status for providers.
  
• Responsible for thorough followup and completion of all member and provider inquiries or requests.
  
• Responsible for accurate complete and correct documentation into Facets regarding all issues inquiries complaints and grievances.
  
• Functions efficiently and productively in a highvolume call center.
  
• Maintains departmental productivity and quality standards.
  
• Provides followup assistance as needed.
  
• Routes escalated calls to the appropriate Member Liaison Specialist Supervisor or Call Center Manager.
  
• Adheres to departmental policies and procedures.
  
• Processes all member transportation requests within one business day of receipt and coordinating all aspects of the process with the clinic provider and member as appropriate or necessary.
  
• Assists members with Web Portal registration and technical support.
  
• Interacts facetoface with members by assisting with front desk coverage.
  
• Serves as a backup for Customer Service Leads as needed.
  
• Handles and resolves escalated issues.
  
• Competes with other projects and duties as assigned.
  

Possesses the Ability To:

• Establish and maintain effective working relationships with the leadership and staff.
  
• Function efficiently and productively in a highvolume call center.
  
• Learn procedures and regulations governing member eligibility and the terminology and documents used while remaining knowledgeable of Health/MediCal benefits and procedures.
  
• Hear and speak well enough to converse on the phone and in person.
  
• Understand and follow oral and written directions.
  
• Speak understand read and/or write a second language in addition to English may be required for some assignments.
  
• Communicate clearly and concisely both orally and in writing.
  
• Utilize computer and appropriate software (e.g. Microsoft Office: Word Outlook Excel PowerPoint) and job specific applications/systems (e.g. Facets) to produce correspondence charts spreadsheets and/or other information applicable to the position assignment.
  

Experience & Education

• High School diploma or equivalent required.
  
• 2 years of experience in a customer/member service or 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 is also qualifying.
  
• Bilingual in English and in one of defined threshold languages (Arabic Farsi Chinese Korean Spanish Vietnamese) required.
  

Preferred Qualifications

• 2 years of Health Maintenance Organization (HMO) MediCal/Medicaid and health services experience preferred.
  

Knowledge of:

• Principles and practices of managed health care health care systems and medical terminology.
  
• Principles and techniques for handling customer service issues.
  
• Personal computers keyboarding and appropriate software to produce correspondence charts spreadsheets and/or other information applicable to the position assignment.
  
• Customer service principles and practices.
  

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