Customer Service Representative

Job Description

Job Description

We are looking for a bilingual Spanish/English Customer Service Representative to support members in a fast-paced healthcare environment in Westminster, California. This is a Contract position focused on delivering responsive service, explaining health plan information clearly, and helping callers resolve concerns with professionalism and empathy. The ideal candidate brings prior call center or customer support experience, strong communication skills, and the ability to navigate member questions while following healthcare guidelines and internal procedures.

Responsibilities:

• Respond to inbound member inquiries and evaluate each situation to provide accurate, timely, and appropriate assistance.

• Explain coverage details, benefit options, and plan-related information to members, family members, providers, and caregivers in a clear and helpful manner.

• Investigate service concerns by identifying root causes, outlining next steps, and ensuring members receive thorough follow-up until issues are addressed.

• Route complex or sensitive matters to leadership or the appropriate internal teams when additional review or action is needed.

• Support outbound outreach efforts and assigned calling campaigns designed to strengthen member engagement and retention.

• Record conversations, actions taken, and required forms accurately in designated systems while maintaining departmental documentation standards.

• Adhere to established workflows, job aids, and service procedures, while sharing process improvement ideas and reporting operational concerns through proper channels.

• Participate in team meetings, training sessions, and ongoing coaching to maintain service quality and support continuous improvement.

• Follow all applicable federal and state healthcare regulations, as well as company policies, in daily member service activities.

• Perform additional customer service and administrative tasks as needed to support department operations.

• High school diploma or equivalent required; bachelor’s degree or comparable relevant experience preferred.
• At least 2 years of customer service experience, ideally in healthcare, health plan support, or a call center environment.
• Working knowledge of healthcare regulatory standards, including Medicare and Medicaid-related requirements, is preferred.
• Strong verbal and written communication skills with the ability to listen carefully, de-escalate concerns, and provide courteous service.
• Ability to manage conversations while entering information accurately and efficiently in real time; typing speed of 40 WPM required and 60 WPM preferred.
• Proficiency with Microsoft Office applications, including Word, Excel, and Outlook.
• Ability to communicate in languages such as Cantonese, Mandarin, Vietnamese, Korean, Spanish, Thai, Khmer, or Japanese may be needed.
• Availability to work some weekends from October through March and willingness to travel occasionally when required.