Customer Service Representatitve Non-Bilingual

Company Overview: Sunshine Enterprise is an industryleading Staffing and Recruitment Firm. Our clients are fortune 500 companies high growth startup companies government and private equity firms and lead professional services firms. 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 Summary

The Customer Service Representative is the first line of contact for 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.

**This is an onsite position.**

Duration: up to 6 months

Position Responsibilities

• Participates in a missiondriven culture of highquality performance with a member focus on customer service consistency dignity and accountability.
  
• 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.
  
• Serves as a resource for other team members.
  
• Assists the team in carrying out department responsibilities and collaborates with others to support short and longterm 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 inperson or telephonically.
  
• Enters accurate and complete documentation into internal application systems regarding all concerns and/or inquiries from the member and provider interaction.
  
• Communicates builds and maintains internal and external relationships by prompt and accurate service delivery.
  
• Identifies and communicates challenges that might arise with the use of professional judgment while adhering to departmental policies and procedures.
  
• Completes other projects and duties as assigned.
  

Possesses the Ability To:

• Establish and maintain effective working relationships with 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.
  
• 6 months of experience in a call center capacity required.
  
• 6 months of MediCal/Medicaid or health services experience.
  
• Typing speed of 35 words per minute (WPM) 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.
  

Abilities to:

• 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 problemsolve and possess project management skills.
  
• Work in a fastpaced environment and in an efficient manner.
  
• Manage multiple projects and identify opportunities for internal and external collaboration.
  
• Motivate and lead multiprogram teams and external committees/coalitions.
  
• Utilize computer and appropriate software (e.g. Microsoft Office: Word Outlook Excel PowerPoint) and jobspecific applications/systems to produce correspondence charts spreadsheets and/or other information applicable to the position assignment
  

Physical Requirements (With or Without Accommodations):

SUNSHINE ENTERPRISE USA LLC is an Equal Opportunity Employer and does not discriminate on the basis of race or ethnicity religion sex national origin age veteran disability or genetic information or any other reason prohibited by law in employment.