CalOptima Health is seeking a highly motivated an experienced TEMP - Customer Service Representative Sr (OneCare-Bilingual Required) (6) to join our team.  The Customer Service Representative Sr (CSR Sr) will serve as a senior point of contact for OneCare members and providers and will assist them with questions and/or complaints related to the OneCare plan services. The incumbent will provide information regarding eligibility, enrollment, benefits and services to OneCare eligible members and providers. 

Position Information:

- Department: Customer Service
- Work Arrangement: Full Office

Duties & Responsibilities:

- 80% - Program Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Maintains departmental productivity and quality standards. Follows through on and completes all member and provider inquiries or requests during the original member and provider interaction. Serves as a resource for other team members.
- Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
- Maintains departmental productivity and quality standards.
- Follows through on and completes all member and provider inquiries or requests during the original member and provider interaction.
- Serves as a resource for other team members.
- 15% - Administrative Support 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. Enters accurate and complete documentation into internal application systems regarding all concerns and/or inquiries from the member and provider interaction. Communicates, builds and maintains internal and external relationships by prompt and accurate service delivery. Identifies and communicates challenges that might arise with the use of professional judgment while adhering to departmental policies and procedures.
- 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.
- Enters accurate and complete documentation into internal application systems regarding all concerns and/or inquiries from the member and provider interaction.
- Communicates, builds and maintains internal and external relationships by prompt and accurate service delivery.
- Identifies and communicates challenges that might arise with the use of professional judgment while adhering to departmental policies and procedures.
- 5% - Completes other projects and duties as assigned.

Minimum Qualifications:

- High School diploma or equivalent PLUS 6 months of experience in a call center capacity required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
- Typing speed of 35 words per minute (WPM) required.

Preferred Qualifications:

- 6 months of Medi-Cal/Medicaid or health services experience.

Required Licensure / Certifications: