About Us:
Santa Clara Family Health Plan (SCFHP) is a local, community-based health plan dedicated to improving the health and well-being of the residents of Santa Clara County. Working in partnership with providers and community organizations, we serve our neighbors through our Medi-Cal and SCFHP DualConnect (HMO D-SNP) health care plans.
About the role:
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.
Day to Day:
- 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 high customer 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.
About You:
- High School Diploma or GED.
- Minimum one year of experience in Customer Service or Call Center role, preferably within a Health Care, Public Assistance or Human Services programs.
- Prior experience with managed care plans, Medi-Cal and Medicare programs, and working with underserved populations is desired.
- Ability to meet Key Performance Indicators by participating in and achieving the standards of the Customer Service Call Center Quality Program.
- Spanish, Vietnamese, Chinese, or Tagalog language bi-lingual skills is desired.
Please review the full job description on our Career’s page:
https://phf.tbe.taleo.net/phf04/ats/careers/v2/viewRequisition?org=SANTCLAR2&cws=38&rid=849
Job Type: Temporary
Pay: $25.00 per hour
Schedule:
- 8 hour shift
- Day shift
- Monday to Friday
Work Location: In person
