Contact Center Representative I

Job Summary

The Contact Center Representative (CCR) I is the first point of contact for members, providers, and stakeholders, delivering complete, accurate and compassionate support on eligibility, benefits, claims, authorizations, Primary Care Physician (PCP) changes, and other service needs ensuring seamless triage across the healthcare journey.

The CCR I primarily supports L.A. Care’s Medi-Cal and Personal Assistance Services Council (PASC) managed care product lines. This support is provided across all communication channels (inbound, outbound, chat, text, email).

Duties

Responds to inquiries across all channels related to eligibility, benefits, claims, authorizations, and coordination of care. Assists members with navigating their healthcare journey, including understanding their eligibility and benefits, Evidence of Coverage (EOC) and Member Handbook. Provides First Call Resolution (FCR) by addressing the needs of members and providers effectively on the first call. Supports members and providers with navigation of self-service tools. Documents all interactions in L.A. Care’s system of record. Ensures compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations and protects member privacy. Triages and directs calls to the appropriate internal teams or external entities for resolution. (80%)

Supports ad-hoc targeted member outreach activities as determined by business need. (10%)

Performs other duties as assigned. (10%)

Duties Continued

Education Required

Education Preferred

Experience

Required:

At least 1 year of customer service contact center experience in a healthcare environment.

Data entry experience with ability to type a minimum of 40 words per minute.

Preferred:

Member Services contact center experience in a Managed Care plan. 

Skills

Required:

Ability to answer a high volume of calls while demonstrating a high level of empathy and patience.

Knowledge of managed care terminology.

Familiarity with HIPAA regulations and confidentiality practices.  

Strong verbal and written communication skills.

Strong probing, problem-solving and multitasking skills.

Ability to work independently and as part of a team.

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’s Contact Center is open 24 hours a day, 7 days a week, including holidays. Contact Center work shifts are assigned based on business need and may include, but not be limited to, evenings, weekends and holidays.