Customer Service Representative

Regal Medical Group - Northridge, CA (30+ days ago)2.9


As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

We currently have an opening for a Customer Service Representative.

Under general supervision, respond to telephone inquiries from members, Health Plans, providers and employer groups to provide information and clarification relating to RMG services such as claims, referrals, and eligibility in resolving inquiries.

1. Receives incoming calls involving multiple issues from members, Health Plans and providers.
2. Maintains or exceeds quality and productivity standards.
3. Researches and resolves routine or complex issues relating to services provided by GCMG. This can include eligibility, referral status, provider availability and claim related issues.
4. Process member address and phone number changes.
5. Facilitates the processing of telephone appeals, inquiries or complaints, statement of concerns involving a member by accurately and timely collection of information.
6. Ability to work independently in the resolution of complaints and other service related issues.
7. Handles designated assignments and prioritize work in order to maintain workflow.
8. Display professionalism, good judgment, maturity, and fairness when interacting with others.
9. Performs copy and fax functions as needed.
10. Maintains accurate and good grammatical communication, both verbal and written, with all levels of management, staff, members and providers.
11. Follow HIPAA guidelines and maintains confidentiality with all information pertaining to the members’ medical information and privacy.
12. Displays warm and pleasant phone personality, emphasizing tact, empathy, and patience.
13. Back-up receptionist as needed.
14. Coordinate Employee events and holiday luncheons.
15. Assist Provider Relations Representative as needed/Network Manager.
16. Other duties as assigned.

We offer a full benefits package which includes employer paid medical, pharmacy and dental benefits. We offer a generous PTO package, 401k Retirement Savings, Life Insurance, Flexible Spending Account (FSA), Tuition Reimbursement & Licensed Renewal Fees for our clinical staff.

Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.