Job ID# 1004888- 49 – Posted 10/14/22 – Los Angeles, CA (Remote)

– Answers incoming calls from members, potential members, providers, and advocates.
– Handles and resolves member issues or assists members in connecting with internal units or external parties such as Plan Partners, Primary Care Physician (PCP) offices, pharmacists, etc.
– Provides essential information to members regarding access to care issues, coordination of care issues, benefits, Evidence of Coverage (EOC), Member Handbook, etc. and assist providers in using the Interactive Voice Response (IVR), web portals, and verifying member eligibility.
– Document all calls in the system of record Performs the completion of PCP transfers. Process plan partner changes.
– Verifies eligibility for Plan Partners, Providers and Members.
– Assists Management with projects as needed; assist with new hire shadowing.
– Works with Member Relations Specialist to assist members with complex issues and coordination of care issues within Plan Partners.
– Trouble shoots and directs calls to the appropriate departments. Handles complex call center calls.
– Participate in Quality Scorecard Training and implement recommendations for improvement based on scorecard results.
– Check call center voicemail box as needed.
– Performs other duties as assigned.

– Ability to answer a high volume of calls.
– Knowledge of medical terminology.
– Good understanding of service to the disadvantaged population, seniors and or people with chronic conditions or disabilities. 
– Must be a quick learner, excellent team player and customer service oriented. 
– Bilingual is highly desirable.

– 3+ years of healthcare call center experience;
– 3+ years of Medi-care experience;
– Data entry experience with ability to type a minimum of 40 words per minute.
– Previous ACD experience.
– Managed care or health plan experience

This classification requires the possession of a High School Diploma.

Candidate must be local to Los Angeles County/can drive into Downtown L.A. if needed.

Candidate must be available to work anywhere from 7am to 10pm;

Please send your resume and any additional information to our recruitment team at recruitment@nexlogica.com