Customer Service Representative

You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.

Job Summary

Our client is seeking a Customer Service Representative responsible for acting as the primary point of contact and liaison for members and providers. The role involves answering inquiries, resolving concerns, and providing education on eligibility, medical, and pharmacy benefits while ensuring high customer satisfaction.

Responsibilities / Job Duties

• Act as the primary liaison for members and providers regarding inquiries and information requests.
• Develop an understanding of member-facing materials to respond appropriately to follow-ups.
• Manage high volume calls, handling inquiries about program services and benefits.
• Resolve member and provider inquiries accurately and professionally by following established guidelines.
• Handle and coordinate member grievances and appeals, escalating as needed.
• Educate members and providers on benefits and service access to maintain satisfaction.
• Document all communications accurately in compliance with guidelines.
• Address requests received via email, voicemail, fax, and alternative channels according to procedures.
• Triage and direct member and provider requests to appropriate departments.

Minimum Education and Experience Qualification Requirements

Education

• High School Diploma or GED.

Qualifications

• Minimum one year of experience in a Customer Service or Call Center role, preferably within healthcare or human services programs.
• Ability to meet key performance indicators and quality standards in the Customer Service Call Center.
• Proficient in computer software applications such as Outlook, Word, and Excel.
• Ability to type with moderate speed and high accuracy.
• Preferred: Experience with managed care plans, Medi-Cal and Medicare programs, and Spanish, Vietnamese, Chinese, or Tagalog bi-lingual skills.

Schedule / Shift

Work schedule: Onsite work hours are from 8:30 AM to 5:00 PM, Monday through Friday.

Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
• Short Term Disability Insurance.
• Term Life Insurance Plan.

Required Employment / Compliance Language

* We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).


Medix Overview:

With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we're dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.

* As a job position within our Insurance division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing medical and confidential records, verifying financial information, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients