Job Abstract

• 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.
• Addresses member and provider inquiries, questions and concerns in all areas, including eligibility, enrollment, claims or authorization status, benefit interpretation and referrals/authorizations for medical care, in-person or telephonically.
• Communicates, builds and maintains internal and external relationships through prompt and accurate service.
• Identifies and communicates challenges that might arise with the use of professional judgment while adhering to departmental policies and procedures.
• Serves as a mediator to ensure the interests of members and CalOptima Health are protected.
• Follow-ups and ensures completion of all member and provider inquiries or requests.
• Ensures accurate, complete and correct documentation is entered into Facets regarding all issues and/or inquiries, complaints and grievances.
• Assists in developing and mentoring Customer Service staff.
• Serves as a resource for other team members or internal stakeholders.
• Maintains departmental productivity and quality standards.
• Problem solves escalated challenges.

All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance.