L.A. Care Health Plan CSC Service Representative IV in Los Angeles, California

CSC Service Representative IV

Job Category:

Customer Service

Department:

Customer Solution Call Center

Location:

Los Angeles, CA, US, 90017

Position Type:

Full Time

Requisition ID:

2547

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

The Customer Solution Center Representative IV has advanced knowledge of healthcare and various managed care product lines, Medi-Cal, PASC, L.A. Care Covered/Cal Medi-Connect and proficient in medical terminology. The CSC Representative IV responsibilities include duties such as: assist supporting queues and Management with projects as needed (e.g. provide informative feedback on desktop procedures, follow-up on member inquiries, CSC Representative shadowing etc.…), acting as back-up support to Call Center Supervisors and Leads. This position handles inbound and outbound interactions involving member eligibility verification, general provider inquiries, claim status (pre-payment), general program and administration questions for all lines of business including direct member request for I.D cards and PCP changes, triage of calls to appropriate unit. Processing payments for L.A. Care Covered members, Document all call interactions in system of record.

Duties

Answers incoming calls from members, potential members, 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 members in using the self-service tools where available and verifying member eligibility. Performs the completion of PCP transfers. Process plan partner changes. Process payments for L.A. Care Covered members. Document all calls in the system of record. (50%)

Answers incoming calls from providers regarding general provider inquiries, claim status (pre-payment), general program and administration questions for all lines of business including direct member request for I.D cards and PCP changes, triage of calls to appropriate unit. Handles and resolves provider issues or assists providers in connecting with internal units. Provides essential information to members regarding access to care issues, coordination of care issues, benefits, Evidence of Coverage (EOC) and assist providers in using the self-service tools where available and verifying member eligibility. Performs the completion of PCP transfers. Process plan partner changes. Handles complex calls as needed coordinates with Member Relations Unit to assist members with complex issues and coordination of care issues within Plan Partners. Assist with new hire shadowing as needed and based on performance metrics. Processing payments for L.A. Care Covered members. Document all call interactions in system of record. (20%)

Assists with the timely contact of members regarding member outreach and retention programs for all lines of business via direct member communication, including welcome calls and meeting all regulatory requirement for Health Risk Assessments for CalMediConnect members and well as SPD members. Facilitate member choice assignment and fulfillment of materials in the appropriate language and/or alternative format. This aligned with service level requirements. Ad hoc outreach efforts as determined by business need. (20%)

Perform other duties as assigned. (10%)

Education

High School Diploma/GED

Experience

Required:

With High School Diploma: 2 years customer service telephone experience in a healthcare environment.

Data entry experience with ability to type a minimum of 40 wpm.

Ability to answer a high volume of calls; previous ACD experience preferred.

Preferred:

Managed care or health plan experience.

Professional Licenses

Professional Certifications

Required Training

Additional Information

Preferred:

"Bilingual in one of LA Care Health Plan’s threshold languages is highly desirable. English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese ".

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)