SUMMARY:

Under direct supervision, responsible for responding to and resolving a variety of inquiries, requests and issues from external and internal customers in a call center environment.

YOUR DAY TO DAY:

• 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 Skills

WHAT YOU BRING:

• Ability to efficiently and effectively handle calls of heavy volume (50-100 per day), including documentation and resolution.

• 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.

• Time management and organizational skills. Uses time effectively and efficiently. Values time. Concentrates his/her efforts on the more important priorities. Can attend to a broader range of activities. Meets deadlines.

• Basic problem solving and analytical skills, including the ability to perform routine analysis and solve problems using identified data and 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 type 45 WPM at 90%.

• 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.

WHAT YOU BRING (PREFERRED):

• Knowledge of Medi-Cal programs
• Knowledge of managed care
• Knowledge of medical policy benefits and exclusions
• Knowledge of medical terminology
• Knowledge of ICD and CPT coding.

Required Experience

WHAT YOU HAVE (REQUIRED):

• High school diploma or general education degree; and
• At least one year handling heavy call volume (50-100 calls per day).

WHAT YOU HAVE (PREFERRED):

• Associate’s Degree
• Experience in customer service in a health plan, managed care and/or Medi-Cal.
• Fluency in Spanish

LICENSURE, CERTIFICATION, REGISTRATION

Valid California driver license and reliable transportation or, the ability to obtain transportation on demand in the counties served by HPSJ if prohibited from getting a driver license due to a medically documented disability.

WHAT YOU BRING:

• Ability to efficiently and effectively handle calls of heavy volume (50-100 per day), including documentation and resolution.

• 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.

• Time management and organizational skills. Uses time effectively and efficiently. Values time. Concentrates his/her efforts on the more important priorities. Can attend to a broader range of activities. Meets deadlines.

• Basic problem solving and analytical skills, including the ability to perform routine analysis and solve problems using identified data and 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 type 45 WPM at 90%.

• 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.

WHAT YOU BRING (PREFERRED):

• Knowledge of Medi-Cal programs
• Knowledge of managed care
• Knowledge of medical policy benefits and exclusions
• Knowledge of medical terminology
• Knowledge of ICD and CPT coding.