Customer Service Representative

Summary: Health Plan of San Joaquin/Mountain Valley Health Plan is seeking a Customer Service Representative for their Placerville office. The role involves responding to and resolving inquiries from customers in a call center environment, providing information on benefits and eligibility, and creating necessary documentation. Responsibilities: - Provides information on benefits, eligibility, claims, authorizations and other related items over the phone and in person - Researches and resolves issues related to claims and authorizations; monitors progress - Researches and resolves complex eligibility issues; monitors progress - Creates required documentation, including but not limited to call logs and other tracking systems Required Qualifications: - Produces work that is accurate and complete - Actively learns through experimentation when tackling new problems, using both successes and failures to learn - Rebounds from setbacks and adversity when facing difficult situations - Knows the most effective and efficient process to get things done, with a focus on continuous improvement - Interpersonal skills - interacts effectively with individuals both inside and outside of HPSJ; relates openly and comfortably with diverse groups of people - Strong oral and written communication skills, with ability to express self clearly and professionally, and document according to standards - Strong listening skills, with the ability to accurately receive and understand messages - Basic conflict resolution skills, with the ability to use tact and diplomacy to diffuse emotional situations - Ability to work independently and as part of a team - Demonstrates a commitment to HPSJ's strategy, vision, mission and values - Ability to read, understand and apply complex written guidelines, instructions and other materials - Ability to compare and discern the difference between multiple sets of data or information - Basic arithmetic skills - Basic knowledge of contact center systems - Basic skills in Windows, Word, Excel and Outlook - Ability to navigate multiple systems and resources simultaneously - Ability to handle confidential information with appropriate discretion - Ability to speak and be understood in English - Proficiency (as defined by HPSJ's Cultural and Linguistics Program) in one of HPSJ's threshold languages may be required, depending on business requirements - Must type 40 WPM - Must pass Call Center Listening Skill test with a score of 71+ - High school diploma or general education degree - Customer Service experience Preferred Qualifications: - Ability to efficiently and effectively handle calls of heavy volume (50-100 per day), including documentation and resolution - Knowledge of Medi-Cal programs - Knowledge of Medicare DSNP programs - Knowledge of managed care - Knowledge of medical policy benefits and exclusions - Knowledge of medical terminology - Knowledge of ICD and CPT coding - Associate's Degree - Experience in customer service in a health plan, managed care, Medicare DSNP and/or Medi-Cal - At least one year handling heavy call volume (50-100 calls per day) Required Skills: Contact center systems, Windows, Microsoft Word, Microsoft Excel, Microsoft Outlook, Typing (40 WPM), Call center listening skills, Medi-Cal programs, Medicare DSNP programs, managed care, medical policy benefits, exclusions, medical terminology, ICD coding, CPT coding, Basic arithmetic, Listening skills, work as part of a team, Tact, diplomacy, English language proficiency Benefits: Competitive salary, Robust and affordable health/dental/vision with choices in providers, Generous paid time off (accrue up to 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays), CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution plan, Two flexible spending accounts (FSAs), Employer-Paid Term Life and AD&D Insurance, Employer-Paid Disability Insurance, Employer-Paid Life Assistance Program, Health Advocacy, Supplemental medical, legal, identity theft protection, Access to exclusive discount mall, Education and training reimbursement in addition to employer-paid elective learning courses., A chance to work for an organization that is mission-driven – our members and community are at the core of everything we do., A shorter commute ­– if you’re commuting from the Central Valley to the Bay Area., Visibility and variety – you have a chance to work with people at all levels of the organization, and work on diverse projects.