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Customer Solution Center Service Representative I

Job Category:  Customer Service
Department:  Customer Solution Call Center
Location: 

Los Angeles, CA, US, 90017

Position Type:  Full Time
Requisition ID:  8253

 

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 in five health plans, 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.

As a condition of employment, L.A. Care requires a COVID-19 vaccine. This requirement includes our remote workforce. If you would like to request an exemption, L.A. Care has implemented a process to consider exemptions, for documented medical conditions and sincerely held religious beliefs. L.A. Care will review all exemption requests prior to proceeding with the recruitment process.

Job Summary

The Customer Solution Center Services Representative I is responsible for a successful completion of the Member Services training program and continues to gain strong knowledge of Medi-Cal and PASC managed care product lines. 

The Customer Solution Center Services 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 systems. (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%)

Performs other duties as assigned. (10%)

Education Required

High School Diploma/or High School Equivalency Certificate

Education Preferred

Experience

Required:
At least 6 months customer service call center experience. 

Data entry experience with ability to type a minimum of 40 word 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

Additional Information

 

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)

 

At L.A. Care, we value our team members’ safety. In order to keep our work locations safe, each employee is required to self-screen for symptoms prior to entering any L.A. Care location each day. L.A. Care and all of its staff are required to comply with all state and local masking orders. Therefore, when on-site at any L.A. Care location, employees are expected to wear a mask in areas where physical distancing cannot be managed.


Nearest Major Market: Los Angeles

Job Segment: Call Center Representative, Customer Service Representative, Data Entry, Call Center, Customer Service, Administrative

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