Lead, Customer Service Representative

Position Summary: 

 

This position is responsible for routine audits on individual’s customer service representatives on Customer Service Module and REA/LEAD customers service case, responsible for training the customer service representatives and answers questions relating to eligibility, referrals, provider availability, claims status and department procedures. Handling escalated inquiries from members, Health Plans, providers and employer groups, to provide information and clarification on RMG services.

 

Essential Duties and Responsibilities include the following:

• Receives incoming calls involving multiple issues from members, Health Plans and providers maintain quality and productivity standards
• Conduct and maintain quality assurance progress reports, conduct Q&A reviews by listening to recorded calls and providing training and feedback as necessary
• Audit documentation for accuracy of the customer service module and REA/LEAD Customer Service Cases
• Audit customer service incident reports for RMG, LMG, GCMG and ADOC for timeliness
• Conduct weekly procedural training meetings with customer service representatives to address current issues that impact the CSC department, interact with leadership group to aid in overall staff development and training
• Attend daily and weekly meetings with supervisors and department manager and provide written status and progress reports.
• Researches and resolves routine and complex issues relating to services provided by RMG,LMG GCMG and ADOC. This can include eligibility updates, referral status, claim status, and general information.
• Trains new customer service employees and answers questions relating to eligibility, referrals, provider availability, claims status and department procedures
• Facilitates the processing of telephone appeals, inquiries or complaints, statement of concerns for the member by accurately and timely collection of information
• Work independently and make Auditor/Team Lead decisions when necessary.
• Handle a multitude of assignments and prioritize work in order to maintain workflow.
• Provide assistance and mentoring to other customer service representatives or personnel as needed.
• Ensure written and verbal communication with all levels of management, staff, vendors and property management or accurate and with good grammar.
• Maintain confidentiality with all information pertaining to the members medical information
• Have the required ability to operate well in a call center team environment as a team leader.
• Have a very strong knowledge of customer care techniques and processes.
• Documentation such as general reports on each team member’s performance and targets as well as ensuring that they exceed the targets
• A team leader has the responsibility to motivate and inspire once the peer’s team to surpass their potential as much as possible.

The pay range for this position at commencement of employment is expected to be between  $23- $25 per hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

 

The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

 

Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

 

If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

 

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.

 

Full Time Position Benefits:

 

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