Customer Care Representative – Day Shift

🔥 0 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $25 - $35 / hour

⏰ Full Time

🟢 Junior

💝 Customer Support

🚫👨‍🎓 No degree required

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Sharp HealthCare

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1946

🏥 Healthcare

🧘 Wellness

Healthcare • Nursing • Wellness

Sharp HealthCare is a healthcare organization dedicated to providing high-quality medical services to patients and families. With a commitment to innovation, safety, and excellence, Sharp HealthCare offers a range of career opportunities in nursing, clinical support, administration, and various medical specialties. The organization emphasizes a collaborative work environment and is recognized for its nursing excellence, aiming to advance the science of medicine alongside compassionate patient care.

📋 Description

• Communicate directly and promptly with Plan members, potential members, providers, employer groups, brokers, internal departments, and external agencies • Provide information about Plan products, premiums, benefits, policies, and procedures • Research and resolve customer concerns accurately • Document calls and member concerns, complaints, and appeals • Verify eligibility, enrollment, benefits, claims, authorizations, premiums, and PCP assignments using IDX, MedAccess, Salesforce, and related systems • Add and update member information and generate or retrieve member documents • Answer inquiries about benefits, referrals, PCP changes, ID cards, premium and subsidy amounts, COBRA, and Cal-COBRA procedures • Assist members with coverage understanding, enrollment materials, provider-network services, premium and billing questions • Process ACH and credit-card payments by phone • Collaborate with internal departments, healthcare providers, vendors, employers, brokers, and other customers • Participate in special projects, work groups, proposals, audits, and departmental backup support • Identify and recommend solutions to operational problems • Comply with DMHC, CMS, NCQA, regulatory, and accreditation requirements • Work on assigned projects including member orientation, billing reminders, member education, claims investigation, pharmacy authorizations, appeals, and reimbursement requests

🎯 Requirements

• High school diploma or equivalent • Minimum of six months’ experience as a Customer Call Center Representative • Basic computer and writing skills • Demonstrated knowledge of Plan benefits, policies, and procedures • Knowledge of health maintenance organizations, performance management, and customer satisfaction assessment and delivery • Mature and sound judgment • Superior interpersonal skills • Ability to effectively participate in Customer Care activities • Bilingual skills preferred but not required • Medical office certification, including medical terminology, preferred • Must meet department scorecard, behavior, attendance, and knowledge-assessment standards