Job description

Job Summary

The Customer Solution Center Representative II has proven intermediate and proficient knowledge of healthcare and various product lines (e.g. Medi-Cal and PASC) and medical terminology. Responsibilities include assisting in supporting queues and management. This position provides informative feedback on desktop procedures and follow-up as needed to provide one-call resolution. This position handles first level calls and triages escalated 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 PCP changes, triage of calls to appropriate unit. System use of Cisco, NICE, QMEIS and MEIS.

Duties
Answers incoming calls from members, potential members, providers, and advocates. Handles and resolves member issues or 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. and assist providers in using the Interactive Voice Response (IVR), web portals, and verifying member eligibility. Document all calls in the system of record Performs the completion of PCP transfers. Process plan partner changes. (50%) Verifies eligibility for Plan Partners, Providers and Members. Assists Management with projects as needed; assist with new hire shadowing. Works with Member Relations Specialist to assist members with complex issues and coordination of care issues within Plan Partners. Trouble shoots and directs calls to the appropriate departments. Handles complex call center calls. (30%) Participate in Quality Scorecard Training and implement recommendations for improvement based on scorecard results. Check call center voicemail box as needed. (10%) Performs other duties as assigned. (10%)

ONLY CANDIDATES LOCAL TO LOS ANGELES AREA

Remote position until 2024

Job Types: Contract, Temporary

Pay: $21.00 - $24.00 per hour

Schedule:

• Day shift
• Evening shift

Education:

• High school or equivalent (Required)

Experience:

• healthcare call center: 3 years (Required)
• Medicare: 1 year (Required)

Work Location: Remote

colinoncars.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, colinoncars.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, colinoncars.com is the ideal place to find your next job.