REMOTE (Local in Los Angeles CA)
Job Description:
JOB DUTIES:
Education:
Job Description:
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 healthcare and various managed care product lines, Medi-Cal, PASC and Healthy Kids and medical terminology. The Customer Solution Center Services Representative I handle first level calls involving member eligibility verification, general program and administration questions, knowledge of at least one product or call skillset. Direct member request for I.D. cards and Primary Care Provider (PCP) changes, triage of calls to appropriate unit.
Job Duties
· Answers incoming first level calls from members, potential members, providers and advocates.
· Handle and resolve member issues or assist 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. (40%)
· Documents all calls via the member data base systems. (AEVS/MEIS/ QMEIS). (20%)
· Works with Member Relations Specialist to assist members with complex issues and coordination of care issues within Plan Partners. Troubleshoots and directs calls to the appropriate departments. (10%)
Job Requirements:
- Handle incoming customer service calls
- Dispatch incoming customer phone calls
- Accept customer calls and return customer
- Maintain customer service related information for customer accounts
- Ensure quality customer service and customer satisfaction
- Maintain customer service voicemail and return customer calls
- Provide customers with superior customer service
- Provide customer service for internal customers
- Capturing customer information and answering customer inquiries
- Resolve inbound customer calls regarding account
- Take customer orders and provide high-quality customer service
- Make out going customer service calls
- Work with customer service manager to ensure proper customer service
- Resolve any customer service issues
- Answering inbound calls and providing excellent customer service
- Provide customer support and handling customer inquiries
- Combining excellent customer service skills
- Assure quality customer service to all customers
- Provide exceptional customer service to all customers
- Provide superior customer service with all customer interactions