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Customer Solution Center Service Representative III

Job Category:  Customer Service
Department:  Customer Solution Call Center

Los Angeles, CA, US, 90017

Position Type:  Full Time
Requisition ID:  6475


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.

Job Summary

Under the general direction of leadership and management in the Customer Solution Center, Call Center, the Customer Solution Center Service Representative III handles provider inquiries and issue resolution of Level One (1) inquiries, this includes but not limited to, general inquiries on claims processing and status and eligibility verification. In addition, this position will provide support as-needed to members on in-bound calls as part of the larger role of "one-stop shop" service in the Customer Solution Center.


Assist providers in response to telephonic and electronic inquiries and concerns on all products and paid/unpaid claims. Ensure that accurate information is being given to the provider in a timely manner and with the highest level of customer service. Handle Level One (1) provider inquiries this includes (but not limited to): general inquiries on claims processing, payment status and appeal and eligibility status verification. Document the interaction with the provider, including any resolution or escalation steps in the system of record for each call. Provide detailed information for each call including: Caller information; Information related to request/issue; Resolution information or escalation steps.  Escalate Level Two (2) provider concerns to the Claims Department for resolution (e.g. Provider Disputes, incorrectly paid claims, payment check status, Explanation of Benefits (EOB) requests. (70%)


Support the Call Center in meeting State regulatory requirements by handling member-related inbound calls. (10%)


Perform special projects and ad-hoc assignments when necessary. (10%)


Perform other duties as assigned. (10%)

Education Required

High School Diploma/or High School Equivalency Certificate

Education Preferred


At least 0-2 years of experience in customer service in a high-call-volume healthcare customer service call center, including a minimum of 2 years of general claims inquiry or managed care specialty line of business experience.

Customer service training in a healthcare environment.


Data entry experience with the ability to type a professional minimum of 35 wpm.


Working knowledge of Microsoft Office Suite (e.g. Word, Excel, PowerPoint, Outlook).


Excellent communication skills (written and verbal).


Ability to navigate multiple programs/databases while assisting each caller.


Proficient knowledge in healthcare product lines, medical terminology and claims processes.


Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Technical training/certificate in a technical or business school (e.g. medical billing, medical terminology, medical coding, healthcare).

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: Customer Service Representative, Medical, Claims, Call Center Representative, Medical Coding, Customer Service, Healthcare, Insurance

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