About this role
Salary Range: $45,760.00 (Min.) - $47,823.00 (Mid.) - $55,818.00 (Max.)
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, 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 Service Representative I is responsible for a successful completion of the Member Services training program and continues to gain strong knowledge of Medi-Cal and Personal Assistance Services Council (PASC) managed care product lines.
The Customer Solution Center Service Representative I handles first level calls involving member eligibility verification, general program and administration questions, benefits and services, member requests for I.D. cards and Primary Care Provider (PCP) changes, and triage of calls to appropriate units or outside entities.
Duties
Answers incoming first level calls from members, potential members, providers and advocates. Handles and resolves member issues, 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. Assists providers in using the Interactive Voice Response (IVR) web portal and verifying member eligibility. Documents all calls via the member data base system, QMEIS.
Ensures department compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations relating to protection of personal history information. Troubleshoots and directs calls to the appropriate departments or outside entities. (75%)
Supports robocall and ad-hoc member outreach activities as determined by business need. (15%)
Perform other duties as assigned. (10%)
Duties Continued
Education Required
Education Preferred
Experience
Required:
At least 6 months of customer service call center experience.
Data entry experience with ability to type a minimum of 40 words per minute.
Preferred:
Managed care or health plan experience.
Skills
Required:
Ability to answer a high volume of calls.
Knowledge of medical terminology.
Must be a strong team player, punctual, and has excellent attendance record.
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.
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
Physical Requirements
Additional Information
L.A. Care Health Plan Call Center is available 24 hours a day, 7 days a week, including holidays. Call Center work shifts are assigned based on business need and may include, but not be limited to, evenings, weekends and holidays.
Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
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)
Other facts
About L.A. Care Health Plan
L.A. Care’s mission is to provide access to quality health care for L.A. County’s low-income communities, and to support the safety net required to achieve that purpose. As a publicly operated health plan, L.A. Care Health Plan serves more than 2.6 million members in Los Angeles County, making it the largest publicly operated health plan in the country. L.A. Care offers four health coverage plans including Medi-Cal, L.A. Care Covered™, L.A. Care Medicare Plus and the PASC-SEIU Homecare Workers Health Care Plan, all dedicated to being accountable and responsive to members. L.A. Care prioritizes quality, access and inclusion, elevating health care for all of L.A. County. For more information, follow us on X, Facebook, LinkedIn, Instagram and YouTube.
To learn more, visit www.lacare.org.
*For urgent inquiries: 1-888-4LA-CARE (1-888-452-2273)
What you'll do
- The Customer Solution Center Service Representative I handles first level calls involving member eligibility verification and general program questions. They assist members with issues and connect them with internal and external parties.
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