Customer Service Representative (CSR), Sr. (Bilingual)

November 17, 2022
Orange, CA
Job Type


Customer Service Representative (CSR), Sr. (Bilingual)

Job Description
Department(s): Customer Service
Reports to: Supervisor, Customer Service
FLSA status: Non-Exempt
Salary Grade: D - $21.15 - $30.67 ($44,000 - $63,800)

About CalOptima Health

CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay!

About the Position

The Customer Service Representative Sr is the first line of contact for CalOptima Health members and providers and will assist them with questions related to the Medi-Cal programs for Orange County. The incumbent resolves member inquiries and complaints fairly and effectively. The incumbent provides information regarding eligibility, enrollment, benefits and services to CalOptima Health eligible members and providers.

Position Responsibilities:

  • Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
  • 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 inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care.
  • Verifies member eligibility, claim and authorization status for providers.
  • Responsible for thorough follow-up and completion of all member and provider inquires or requests.
  • Responsible for accurate, complete, and correct documentation into Facets regarding all issues, inquires, complaints and grievances.
  • Functions efficiently and productively in a high-volume call center.
  • Maintains departmental productivity and quality standards.
  • Provides follow-up assistance as needed.
  • Routes escalated calls to the appropriate Member Liaison Specialist, Supervisor or Call Center Manager.
  • Adheres to departmental policies and procedures.
  • Processes all member transportation request within one business day of receipt and coordinating all aspects of the process with the clinic, provider, and member as appropriate or necessary.
  • Assists members with CalOptima's Member Web Portal registration and technical support.
  • Interacts face-to-face with members by assisting with front desk coverage.
  • Serves as a backup for Customer Service Leads, as needed.
  • Handles and resolves escalated issues.
  • Competes other projects and duties as assigned.

Experience & Education:

  • High School diploma or equivalent required.
  • 2 years of experience in a customer/member service or call center capacity required.
  • An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.
  • Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese) required.

Preferred Qualifications:

  • 2 years of Health Maintenance Organization (HMO), Medi-Cal/Medicaid and health services experience preferred.

About our Benefits & Wellness options:

At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options.

CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.

If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. You can request reasonable accommodations with 72-hour notice by contacting Human Resources Disability Management at 657-900-1134.

Job Location: Orange, California
Position Type:

To apply, visit

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