Call Center Audits and Investigation (A&I) Fraud Agent - Hybrid - West Sacramento, CA

Call Center Audits and Investigation (A&I) Fraud Agent - Hybrid - West Sacramento, CA

Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development.

A&I Fraud Agents are responsible for responding to basic to moderately complex fraud telephone calls, handling requests for Medi-Cal and In-Home Supportive Services (IHSS) hotlines complaints of fraud, waste, and abuse and conducting stellar customer service.

Your role in our mission Answers telephone calls using an automated system and responds to basic beneficiary and provider questions and/or forwards call to appropriate personnel. Identify Medi-Cal provider and beneficiary fraud, waste, and abuse, emphasizing fraud prevention in accordance with service level agreements (SLAs). Documents calls in a customer relationship management (CRM) ticketing solution, resolves written provider requests/inquiries and updates provider history with results of inquiry to include proper documentation. Interfaces with team personnel, management, and customers in reference to customer service issues. Conducts outbound calls to providers in response to voicemail inquiries, customer direction or other business needs.

What we're looking for High school diploma or G.E.D. 6 months minimum, prefer on more years of customer service or other telephone experience. Experience working with organizational functions and personnel. Experience working with fax machines, computer software and telephone technology. Experience working with and skilled in the use of help desk software.

What you should expect in this role Business and analytical critical thinking skills. Communication skills both written and oral. Ability to work independently, follow oral and written directions. Ability to navigate Microsoft Word, Microsoft Teams, Microsoft Outlook, and internet browsers. The position is hybrid but will be required to work onsite at the West Sacramento Office two to three days per week.