Contact Center Care Coordinator (on-site position)

This role will be on-site at the Camarillo, CA office.
Bilingual knowledge in English/Spanish is highly preferred.
Willingness to work flexible hours, including evenings, weekends, and holidays as required. Gold Coast Health Plan will not sponsor applicants for work visas.

The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California.

POSITION SUMMARY

Gold Coast Health Plan is a leading healthcare organization dedicated to providing exceptional member care and support. We prioritize member well-being and aim to deliver high-quality member services through our dedicated team of professionals. As a Contact Center Care Coordinator I, you will play a pivotal role in ensuring seamless coordination and assistance for members seeking medical support and information.

Job Summary:

The Contact Center Care Coordinator I is responsible for providing outstanding customer service and support to members, caregivers, and healthcare professionals who contact Gold Coast Health Plan. This role involves managing inbound and outbound calls, emails, and other communication channels to support members in accessing healthcare services, scheduling appointments, addressing inquiries regarding medical procedures, billing, and general information enrollment, eligibility, provider network authorization, plan guidelines and processes. This position handles inbound and outbound interactions involving member eligibility verification, general provider inquiries, claim status, general program and administration questions including direct member request for I.D cards and Primary Care Physician (PCP) changes, and triaging calls to appropriate units or outside entities. All interactions are documented in the system of record.

ESSENTIAL FUNCTIONS

Reasonable Accommodations Statement

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

Essential Functions Statements

• Explain GCHP procedures, protocols, benefits, services and information to members, providers and advocates as required through incoming calls, emails, and other communication channels promptly and professionally.

• Provide members essential information regarding access to care, coordination of care, benefits, Evidence of Coverage (EOC), Member Handbook, etc.

• Troubleshoot and resolve escalated issues following established protocols and guidelines to escalate urgent matters or complex issues to appropriate personnel.

• Provide members with accurate information about eligibility, benefits, claim status, and authorization requirements.

• Process member ID card requests and perform other Member Services related tasks, functions, and special projects.

• Assist members and caregivers in scheduling appointments, coordinating referrals, and navigating healthcare services.

• Provide accurate and up-to-date information about medical procedures, services, and facilities.

• Collaborate with healthcare providers and internal teams to ensure efficient and accurate communication of member needs and information.

• Supports members in connecting with internal departments or external parties such as Community Supports, Primary Care Physician (PCP) offices, pharmacists, etc.

• Assist providers and members in using the Interactive Voice Response (IVR) and web portal.

• Ensure department compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations relating to protection of personal history information. This includes adherence to compliance standards, confidentiality, and data protection regulations in all interactions and communications.

• Maintain an up-to-date and thorough knowledge of GCHP guidelines.

• Provide accurate research to resolve issues regarding eligibility, benefits, claims and authorizations using appropriate systems.

• Properly document all calls/contacts as required by department standards in a timely, clear, and concise manner using GCHP's internal tracking system.

• Review training/educational material and seek clarification when needed.

• Support robocall and ad-hoc member outreach activities as determined by business need.

• Achieve and maintain acceptable performance levels according to the Member Servi