Customer Service Representative - Sunshine Enterprise USA LLC

Customer Service Representative

Company Overview: Our client is a leading healthcare located in Orange, CA, seeking a senior customer service representative, performing as a point of contact for questions and/or complaints related to plan services.

Position Summary: The ideal candidate shall have at least 1 year of call center capacity at a healthcare setting.

Work Duration: Up to 6 months

Job Type: On-site

Position Responsibilities

• 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.
• 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.
• Completes other duties or projects as assigned.

Experience & Education

• High School diploma or equivalent required.
• Typing speed of 35 words per minute (WPM) required.
• 1 year of call center experience at a healthcare setting required.

Necessary Attributes:

• Develop rapport and establish and maintain effective working relationships with leadership and staff and external contacts at all levels and with diverse backgrounds
• Work independently and exercise sound judgment.
• Communicate clearly and concisely, both orally and in writing.
• Work a flexible schedule; available to participate in evening and weekend events
• Organize, be analytical, problem-solve and possess project management skills
• Work in a fast-paced environment and in an efficient manner.
• Manage multiple projects and identify opportunities for internal and external collaboration.
• Motivate and lead multi-program teams and external committees/coalitions.
• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment
• Ability to visually read information from computer screens, forms and other printed materials and information.
• Ability to speak (enunciate) clearly in conversation and general communication.
• Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
• Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
• Lifting and moving objects, patients and/or equipment 10 to 25 pounds

Please see HR for information on physical demands and work environment of this job.

Sunshine Enterprise USA is an “Equal Opportunity Employer—Minorities, Females, Veterans and Disabled Persons”