Customer Service Representative I

This is a fully remote position, open to applicants in California.

📋 Description

• Manage customer calls to address issues, provide information, follow up, and respond to inquiries regarding the California Choice plan administration and procedures.

• Respond to group inquiries via phone or email concerning new hires, billing, rates, supplies, and administrative processes.

• Inform employees and their dependents about ID cards, administrative procedures, dependent coverage, and changes of address.

• Follow up with brokers about provider-related issues impacting their groups.

• Engage daily with brokers, general agents, and sales representatives regarding California Choice processes.

• Handle provider calls to verify eligibility and benefits.

• Confirm enrollments and resolve carrier-related issues.

• Accelerate member enrollment processing with carriers when urgent services are required.

• Review and submit group appeal requests.

• Audit group billing and clearly explain it to clients with accuracy.

• Log calls in the call tracking system.

• Operate in a paperless environment utilizing Doc Link.

• Achieve an average score of 90% or higher on call reviews.

• Respond to at least 100% of the daily average call volume.

• Maintain a documentation quality of 90% or above in relevant databases, including Doc Link and Opportunity.

• Limit busy time to 20 minutes or less per day.

• Meet departmental and team standards for quality, quantity, and turnaround times.

• Comply with HIPAA and PHI regulations.

• Ensure regular attendance and punctuality for both on-site and remote work.

• Perform additional assigned business tasks or functions.

⛳️ Requirements

• CA Life & Health license is required, or must be obtained within six (6) months of the hire date.

• Exceptional verbal and written communication abilities.

• Capacity to manage irate customers with courtesy, patience, calmness, and positivity.

• Experience in handling a high volume of calls.

• Proficient in Microsoft Word, Excel, Outlook, Windows, MSWord, and Doc Link.

• Accurate data entry capabilities.

• Typing speed of 55 WPM or higher.

• Knowledge of the health insurance industry is preferred.

• A minimum of two (2) years of customer service experience is preferred.

• Ability to thrive in a fast-paced environment and manage multiple tasks simultaneously.

• Strong problem-solving skills.

• Proficient command of the English language.

• Spanish language proficiency is advantageous.

• Language Assistance Certification must be obtained every two years if employed as a Bilingual representative.

• High school diploma or equivalent is required.

• Capability to sit for prolonged periods and occasionally stand and walk.

• Adequate hearing for telephone communication; close vision and the ability to adjust focus.

• Competence in effectively communicating in English.

• Ability to operate a keyboard and other office equipment.

• Capacity to lift up to 30 pounds occasionally.

🏝️ Benefits

• Comprehensive health, dental, and vision insurance.

• Retirement savings plan with employer matching contributions.

• Generous paid time off and holidays.

• Professional development opportunities.

• Flexible work arrangements.