Overview
Customer Service Representative Jobs in San Jose – California – USA at Santa Clara Family Health Plan
FLSA Status:Non-Exempt
Department:Customer Service
Reports To:Supervisor, Customer Service
Employee Unit:Employees in this classification are represented by Service Employees International Union (SEIU) Local No. 521
GENERAL DESCRIPTION OF POSITION
The Customer Service Representative I answers inbound calls and makes outbound calls to support Customer Service Department operations in a manner that maintains compliance with Medicare and Medi-Cal regulatory requirements and achieves Call Center service-level objectives.
ESSENTIAL DUTIES AND
RESPONSIBILITIES
To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below.
Act as the primary point of contact and liaison for SCFHP members and providers contacting the plan regarding general inquiries, concerns or requests for information.
Develop a general understanding of all member facing materials, communications and interactions and be prepared to respond appropriately to follow up calls.
Answer inbound calls and/or place outbound calls in a high call volume environment and work directly with members and providers to accurately and completely answer inquiries involving SCFHP program services and benefits.
Follow established guidelines and resources to respond to member and provider inquiries and resolve concerns in an accurate, timely, professional, and culturally competent manner.
Intake, handle and coordinate member grievances, appeals and billing issues, escalating to the Grievance and Appeals department, when necessary.
Educate members and providers on eligibility, and medical and pharmacy benefits and how to access services in a manner that achieves excellent service standards and maintains highcustomer satisfaction.
Use listening skills and judgment to appropriately categorize and accurately document all contacts and follow-up actions regarding member and provider communications and activities in accordance with established guidelines.
Appropriately handle member and provider requests through alternative channels such as e-mail, voicemail, fax, walk-in, etc. in accordance with established procedures.
Triage member and provider requests or inquiries for other departments.
Conduct member surveys as assigned in accordance with established guidelines.
Attend and actively participate in daily, weekly, and monthly departmental meetings, in-services, training and coaching sessions.
Identify member/provider issues and trends and report relevant information to management.
Perform other related duties as required or assigned.
REQUIREMENTS – Required (R) Desired (D)
The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.
High School Diploma or GED. (R)
Minimum one year of experience in Customer Service or Call Center role, preferably within a Health Care, Public Assistance or Human Services programs. (R)
Prior experience with managed care plans, Medi-Cal and Medicare programs, and working with under served populations. (D)
Ability to meet Key Performance Indicators by participating in and achieving the standards of the Customer Service Call Center Quality Program. (R)
Spanish, Vietnamese, Chinese, or Tagalog language bi-lingual skills. (D)
Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications, such as Outlook, Word and Excel. (R)
Ability to use a keyboard with moderate…
Title: Customer Service Representative
Company: Santa Clara Family Health Plan
Location: San Jose – California – USA
Category: Customer Service/HelpDesk, Administrative/Clerical
