Customer Service Rep Sr
Customer Service Rep Sr
Posted on :
13-04-2025
Employer Active
1 Vacancy
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Job Description
Customer Service Rep Senior Temp
Sunshine Staffing is seeking Customer Service Rep Senior! This individual is communicative organized and responsible. They will be using problemsolving skills to address matters of eligibility verification and other daytoday services.
Responsibilities:
- 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 inquires or requests.
- Responsible for accurate complete and correct documentation into Facets regarding all issues inquires 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 request 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 our 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.
Qualifications:
- 2 years of Health Maintenance Organization (HMO) MediCal/Medicaid and health services experience preferred.
- 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 Arabic Farsi Chinese Korean Spanish or Vietnamese required.
Necessary Attributes:
- Establish and maintain effective working relationships with CalOptima Healths 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 CalOptima 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.
- 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.
At Sunshine Enterprise USA LLC we firmly believe that our employees are the heartbeat of our organization and we are happy to offer the following benefits:
Competitive pay & weekly paychecks
Health dental vision and life insurance
401(k) savings plan
Awards and recognition programs
Benefit eligibility is dependent on employment status.
Employment Type
Temp
Department / Functional Area
Key Skills
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