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 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 handles 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.
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%)
Verifies Eligibility for Plan Partners, Providers and Members. (5%)
Participates in Quality Scorecard Training and implement recommendations for improvement based on scorecard results. (5%)
Ensures department compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations relating to protection of personal history information. (5%)
Excellent attendance record and no unapproved absences during the first week of the month. Punctuality in arriving at work and in returning from lunches or breaks. (5%)
Performs other duties as assigned. (10%)
Education Required
High School Diploma/or High School Equivalency Certificate
Education Preferred
Experience
Required:
At least 0-6 months customer service telephone experience in a healthcare environment.
Data entry experience with ability to type a minimum of 40 word per minute.
Preferred:
Previous ACD experience.
Skills
Required:
Ability to answer a high volume of calls.
Knowledge of medical terminology.
Must be a strong team player, punctual, and has excellent attendance record.
Good understanding of service to the disadvantaged population, seniors and or people with chronic conditions or disabilities.
Must be a quick learner, excellent team player and customer service oriented.
Preferred:
Bilingual in one of L.A. Care Health Plan’s threshold languages is highly desirable. English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese.
Licenses/Certifications Required
Licenses/Certifications Preferred
Required Training
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.
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