Customer Solution Center Service Representative III

L.A. Care Health Plan is seeking a Customer Solution Center Service Representative III to handle provider inquiries and issue resolution in the Customer Solution Center Call Center. The role requires a high school diploma, 2 years of experience in customer service, and skills in Microsoft Office Suite and healthcare product lines.

Requirements

• Assist providers in response to telephonic and electronic inquiries and concerns on all products and paid/unpaid claims.
• Handle Level One (1) provider inquiries, including general inquiries on claims processing, payment status and appeal and eligibility status verification.
• Document the interaction with the provider, including any resolution or escalation steps in the system of record for each call.
• Escalate Level Two (2) provider concerns to the Claims Department for resolution.
• Provide training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed.
• Support the Call Center in meeting State regulatory requirements by handling member-related inbound calls.
• Perform special projects and ad-hoc assignments when necessary.
• Perform other duties as assigned.

Benefits

• Paid Time Off (PTO)
• Tuition Reimbursement
• Retirement Plans
• Medical, Dental and Vision
• Wellness Program
• Volunteer Time Off (VTO)