Call Center Representative I (California Only)

Pinnacle Claims Management Job Opportunity

If you're looking for a career that provides affordable health benefit solutions to the people who support some of the most vital industries, we're looking for you. At Pinnacle Claims Management, we are an innovative third-party administrator that provides a full-suite of comprehensive and customized health benefits administration services for self-funded companies, including health management and wellness solutions, and pharmacy benefit management. As part of the Western Growers Family of Companies, we are committed to providing our employees with everything they need to succeed and grow. We know that taking care of our clients starts with taking care of our employees. As a keystone of our philosophy, we recognize that every person on our team comes to us with a unique background, history and story that adds strength to our organization. Additionally, employees are encouraged to recognize that there isn't a work life and a home life, there is one life. This recognition throughout the organization emphasizes the value of finding a healthy and happy balance in every employee's life. One way this is realized for employees of Pinnacle Claims Management is flexible work arrangements with work-from-home, in-office or hybrid options. With competitive compensation packages, premier investment support, enriching personal development and more, we strive for our employees' job satisfaction and success.

Compensation: $38,625.60- $50,874.31 with a rich benefits package that includes profit-sharing.

Job Description Summary

The CCSB Call Center Representative I will be at the forefront of providing exceptional customer service and technical support. This role is responsible to work with a diverse group of stakeholders, including Covered California Certified Insurance Agents and Certified Enrollment Counselors. The Call Center Representative I will play a crucial role in assisting clients over the phone and electronically, making a real difference in their experience with the Health Benefits Exchange (HBEX).

Qualifications

• High School diploma or GED with 1-3 years in customer service, preferably in a technical support role within a call center environment, preferred.
• Excellent communication, time management, and team-building skills. Capable of researching and resolving technical issues independently or with minimal support.
• Proficiency in Microsoft products, including but not limited to Word, Teams, and Outlook, for data entry and information processing.
• Ability to learn new software and navigate multiple systems at once. Strong knowledge of Customer Relationship Management (CRM) software. Basic computer experience and keyboarding skills.
• Ability to adapt to a constantly changing environment.
• Knowledge of government regulations, federal, state, and local health benefit programs are preferred.
• Strong written and verbal communication skills, including a clear and concise speaking voice and active listening.
• Bilingual in Spanish, Chinese, Korean, or Vietnamese is a plus.
• Internet access provided by a cable or fiber provider with 40 MB download and 10 MB upload speeds.
• Home router with wired Ethernet (wireless connections and hotspots are not permitted).
• A designated room for your office or steps taken to protect company information (e.g., facing computer towards wall, etc.)
• A functioning smoke detector, fire extinguisher, and first aid kit on site.

Duties And Responsibilities

Customer Advocate

• Manage inbound calls in a timely and professional manner. Address customer inquiries, provide accurate information, and resolve issues.
• Build and maintain relationships with Agents, Certified Enrollment Counselors, and federal and state agency contacts.
• Become a subject matter expert in HBEX, State Provided Programs, and HealthCare.Gov.
• Serve as a representative of the Agent by displaying professionalism, knowledge, and discretion in all interactions with other members of the Agent's community and their customers.
• Enhance the Customer Experience by continuously looking for ways to improve the overall customer experience.
• Maintain composure, manage emotions, and avoid aggressive behavior, even in difficult situations.
• Adhere to the call center Quality Guidelines to ensure the best phone support for our callers.
• Stay adaptable in a constantly changing environment.
• Accepting criticism and handling high-stress situations calmly and effectively.

Call Center Support

• Provide telephonic and web-based outreach to assist with all aspects of the application process within the Covered California systems from sign-up to termination.
• Meet and maintain all department service metrics and performance objectives.
• Contribute to meeting contractual obligations with Covered California.
• Be open to change and embracing a variety of tasks.
• Demonstrate skills in time management and team building.
• Thoroughly document information, activities, and changes in the database and inquiry outcomes for accurate tracking and analysis. Be pleasant with colleagues and display a cooperative, good-natured attitude.
• Be reliable, responsible, and dependable.

Other

• Utilize all capabilities to satisfy one mission to enhance the competitiveness and profitability of our members. Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning, and executing work helpfully and collaboratively. Be willing to adjust efforts to ensure that work and attitude are helpful to others, be self-accountable, create a positive impact, and be diligent in delivering results.
• Maintain internet speed of 40 MB download and 10 MB upload and router with wired Ethernet.
• Maintain a HIPAA-compliant workstation and utilize appropriate security techniques to ensure HIPAA-required protection of all confidential/protected client data.
• Maintain and service safety equipment (e.g., smoke detector, fire extinguisher, first aid kit).
• All other duties as assigned.

Physical Demands/Work Environment

The physical demands and work environment described here represent those that an employee must meet to successfully perform this job's essential functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to communicate with others. The employee frequently is required to move around the office. The employee is often required to use tools, objects, and controls. This noise level in the work environment is usually moderate.