Job Description
Department(s): Customer Service (CS)
Reports to: Manager, Customer Service
FLSA status: Non-Exempt
Salary Grade: E - $23.08 - $32.79 ($48,000 - $68,200)


About CalOptima Health

CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay!

About the Position

The Customer Service Coordinator will support Customer Service (CS) management by resolving member issues and assisting with other call center activities. The incumbent will coordinate member's immediate healthcare needs with health networks, providers and other CalOptima Health department. The incumbent must remain up to date on the latest information about CalOptima Health's member benefits, policies and procedures in order to provide accurate information/case resolution to members.


Duties and Responsibilities:

• Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
• Handles case load, research and ensure cases are resolved within departmental and regulatory standards.
• Maintains documentation of member cases in FACETS system.
• Provides assistance and education to members regarding benefits, health coverage and continuity of care issues.
• Assesses members' concerns to identify psychosocial or health care issues and facilitate an appropriate resolution.
• Initiates referrals to both internal and external care management departments, and other government or outside agencies.
• Communicates with community-based organizations, health networks, providers and vendors on behalf of members to resolve disputes, helps with coordinating access to care and to investigate issues preventing members from receiving medical benefits and services.
• Identifies cases needing case management or escalation to a supervisor, manager, or director and routes according to established guidelines.
• Completes other projects and duties as assigned.

Experience & Education:

• High School diploma or equivalent required.
• 2 years of experience as a call center agent, or customer/member service in a Managed Care plan required.
• An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.

Preferred Qualifications:

• Bachelor's degree in Healthcare Management or related field.
• 1 year of experience handling healthcare coordination/casework in a customer/member service capacity.
• HMO, Medi-Cal/Medicaid, and health services experience.

About our Benefits & Wellness options:

At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options.

CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.

If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.



Job Location: Orange, California
Position Type:

To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4100

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