Customer Service Representative I

Santa Clara Family Health Plan - San Jose, CA (30+ days ago)3.9

POSITION TITLE: Customer Service Representative I

DEPARTMENT: Customer Service Department

REPORTS TO: Supervisor, Customer Service


LOCATION: Campbell, CA

SALARY RANGE: $18.56 - $26.92

EMPLOYEE UNIT: Employees in this classification are represented by Service Employees International Union (SEIU) Local No. 521.

LAST MODIFIED: 3/22/2017

The Customer Service Representative I answers inbound calls and makes outbound calls to support Customer Service Department operations in a manner that maintains compliance with Medicare and Medi-Cal regulatory requirements and achieves Call Center service level objectives.

To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below.

1. Answer inbound calls and/or place outbound calls in a high call volume environment and work directly with members and providers to answer inquiries involving SCFHP program services and benefits accurately and completely.

2. Follow established guidelines and resources to respond to member and provider inquiries and resolve concerns in an accurate, timely, professional, and culturally competent manner.

3. Educate members and providers on benefits and how to access services in a manner that achieves excellent service standards and maintains high customer satisfaction.

4. Accurately document and categorize all contacts and follow-up actions regarding member and provider communications and activities in accordance with established guidelines.

5. Appropriately handle member and provider requests through alternative channels such as e-mail, voicemail, fax, walk-in, etc. in accordance with Call Center established procedures.

6. Attend and actively participate in daily, weekly, and monthly departmental meetings, in-services, training and coaching sessions.

7. Identify member/provider issues and trends and report relevant information to management.

8. Perform other related duties as required or assigned.

REQUIREMENTS – Required (R) Desired (D)
The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.

Minimum High School Diploma or GED. (R)
Minimum one year of experience in Customer Service or Call Center, Health Care, Public Assistance or Human Services programs. (R)
Prior experience with managed care plans, Medi-Cal and Medicare programs, and working with underserved populations. (D)
Ability to meet Quality and productivity Key Performance Indicators by participating in and achieving the standards of the Customer Service Call Center Quality Program. (R)
Ability to consistently meet Attendance Key Performance Indicator by being punctual and meeting the Customer Service Call Center standards in accordance with the team schedule. (R)
Spanish, Vietnamese, Chinese, or Tagalog language bi-lingual skills. (D)
Working knowledge of and the ability to efficiently operate all applicable computer software including a working knowledge of computer applications, such as Outlook, Word and Excel. (R)
Ability to use a keyboard with moderate speed and a high level of accuracy. (R)
Excellent communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP Plan members and providers over the telephone, in person or in writing. (R)
Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R)
Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R)
Ability to maintain confidentiality. (R)
Ability to comply with all SCFHP policies and procedures. (R)
Ability to perform the job safely with respect to others, to property, and to individual safety. (R)

Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications.

Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation:
1. Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R)
2. Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R)
3. Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R)
4. Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R)
5. Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R)
6. Emotional/Psychological Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail. (R)

General office conditions. May be exposed to moderate noise levels.

Self-directed and able to work independently and as part of a team with supervision, able to exercise judgment and make decisions appropriate for the scope of the position, meet critical deadlines; follow up on assignments; handle multiple tasks simultaneously and demonstrate flexible nature. (E)
Familiar with computerized applications such as Word, and Outlook, etc. (E)
Proficient with math at the basic skill level. (E)
Excellent verbal and written communication skills; able to express oneself clearly and concisely. Able to effectively communicate essential information in writing. (E)
Present oneself in a professional manner when dealing with providers and SCFHP staff. (E)
Able to identify, understand, protect and maintain the confidentiality of all sensitive documents, records, discussions and other information generated in connection with any activities within the scope of this position. (E)
Physical requirements: able to operate a keyboard and sit for long periods of time; able to read close up and do close up work; able to perform repetitive motion (keyboard) and writing (note taking); able to hear normal speech and to hear and talk on the telephone. (E)
Complies with all SCFHP policies and procedures; perform job safely with respect to others, to property and to individual safety. (E)