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.
Work Culture:
GCHP strives to create an inclusive, highly collaborative work culture where our people are empowered to grow and thrive. This philosophy enables us to create the health plan of the future and do our best work – Together.
GCHP promotes a flexible work environment. Employees may work from a home location or in the GCHP office for all or part of their regular workweek (see disclaimer).
GCHP’s focuses on 5 Core Values in the workplace:
· Integrity
· Accountability
· Collaboration
· Trust
· Respect
Disclaimers:
· Flexible work schedule is based on job duties, department, organization, or business need.
· Gold Coast Health Plan will not sponsor applicants for work visas.
POSITION SUMMARY
The 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 Medical Contact Center Care Specialist, you will play a pivotal role in ensuring seamless coordination and assistance for members seeking medical support and information.
The Contact Center Care Specialist is responsible for providing outstanding customer service and support to members, caregivers, and healthcare professionals who contact our medical center. This role involves effectively managing inbound and outbound calls, emails, and other communication channels, to efficiently assist members in accessing healthcare services, scheduling appointments, and addressing inquiries regarding medical procedures, billing, and general information enrollment, eligibility, provider network authorization, plan guidelines and processes. Working across departments/functions to expedite resolution and to eliminate further escalation resulting in a complaint or grievance.
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
Job Function & Responsibilities
• Responds to internal and external requests for information within scope of assigned responsibility and departmental guidelines.
• Ability to work independently and have strong organization and planning skills.
• Consistently above QA/FCR/production goals with high degree of accuracy.
• High level of proficiency with multiple GCHP system i.e. CRM/HealthEdge and MS Office suite such as Excel, Word, Teams, Outlook.
• Ability to adapt to different healthcare market segments.
• Coordinates and/or independently completes special projects such as presentation materials.
• Proficient knowledge of Contact Center/Medi-Cal operational concepts, practices, and procedures.
• Meets or above QA/FCR/production goals with high degree of accuracy.
• Demonstrated proficiency with multiple GCHP system i.e. CRM/Health Edge and MS Office suite such as Excel, Word, Teams, Outlook.
• Adaptability to rapidly changing business demands.
• Explains GCHP procedures, protocols, benefits, services and information to members as required.
• Provides accurate information about eligibility, benefits and claim status and authorization requirements to serve members in a courteous and professional manner.
• Functions efficiently and productively in all required duties.
• Handles and resolves escalated issues.
• Maintains an up-to-date and thorough knowledge of GCHP guidelines.
• Provides accurate research to resolve issues regarding eligibility, benefits, claims and authorizations using appropriate systems.
• Properly documents all calls/contacts as required by department standards in a timely, clear and concise manner using GCHP's internal in person tracking system.
• Provides onsite assistance with member-oriented event as needed.
• Reviews training/educational material and seek clarification when needed.
• Maintains strict confidentiality of all sensitive information.
• Refers unresolved issues to the next level and/or appropriate area when necessary.
• Achieves and maintain acceptable performance levels according to the Member Service standards.
• Utilizes documents using Microsoft Office and other applicable software, as designated by management.
• Performs general clerical duties to include but not limited to photocopying, faxing, mailing, and filing.
• Processes member ID card requests and performs other Member Services related tasks, functions and special projects.
• Handle incoming calls, emails, and other communication channels promptly and professionally.
• 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.
• Address member inquiries regarding billing, insurance coverage, and financial assistance programs.
• Collaborate with healthcare providers and internal teams to ensure efficient and accurate communication of member needs and information.
• Document member interactions, maintain accurate records, and update patient information in the system/database.
• Follow established protocols and guidelines to escalate urgent matters or complex issues to appropriate personnel.
• Adhere to compliance standards, confidentiality, and data protection regulations in all interactions and communications.
• Participate in training sessions to stay updated on medical procedures, services, and changes in healthcare policies.
• Strive to achieve key performance indicators (metric goals) related to call handling, customer satisfaction, and service quality.
MINIMUM QUALIFICATIONS
Education & Experience:
• High School Diploma Required.
• AA or BA Preferred but not required
• 5 - 7 years of experience in Customer Service. Strongly Preferred.
• Bilingual in English/Spanish (Preferred)
• Contact center experience advantageous.
• Preferred experience in the health care field interacting directly with members.
• Direct experience with Medi-Cal guidelines and health insurance rules and regulations a plus.
• Prior experience in a healthcare setting, call center, or customer service role is advantageous.
• Strong communication skills, both verbal and written, with the ability to convey complex information in a clear and concise manner.
• Empathetic and patient-focused approach in dealing with diverse patient needs and inquiries.
• Proficient computer skills and familiarity with electronic health records (EHR) systems or customer relationship management (CRM) software.
• Ability to multitask, prioritize tasks efficiently, and work in a fast-paced environment.
• Excellent organizational skills and attention to detail.
• Willingness to work flexible hours, including evenings, weekends, and holidays as required."
Equivalent In lieu of degree:
Will accept experience in any combination of academic education, professional training, or work experience, which demonstrates the ability to perform the duties of the position.
5 -7 years of experience in Health Care and knowledge of Medi-Cal in lieu of a bachelor’s degree.
KNOWLEDGE, SKILLS & ABILITIES
Preferred Qualifications:
• Ability to work collaboratively with others.
• Ability to be detailed oriented.
• Ability to provide constructive feedback to peers and members. Familiar with and be able to interpret policy and procedures.
• Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.
• Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.
• Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information."
• Additional experience or related experience in managed care, Medi-Cal, Medicare, leadership experience, etc.
Technology & Software Skills: Proficient computer skills in MS Office products.
Certifications & Licenses: A valid and current Driver's License, Auto Insurance, and professional licensure(s)
Competency Statements
• Management Skills - Ability to organize and direct oneself and effectively supervise others.
• Business Acumen - Ability to grasp and understand business concepts and issues.
• Decision Making - Ability to make critical decisions while following company procedures.
• Goal Oriented - Ability to focus on a goal and obtain a pre-determined result.
• Interpersonal - Ability to get along well with a variety of personalities and individuals.
• Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.
• Time Management - Ability to utilize the available time to organize and complete work within given deadlines.
• Consensus Building - Ability to bring about group solidarity to achieve a goal.
• Relationship Building - Ability to effectively build relationships with customers and co-workers.
• Presentation Skills - Ability to effectively present information publicly.
• Delegating Responsibility - Ability to allocate authority and/or task responsibility to appropriate people.
• Leadership - Ability to influence others to perform their jobs effectively and to be responsible for making decisions.
• Strategic Planning - Ability to develop a vision for the future and create a culture in which the long-range goals can be achieved.
• Ethical - Ability to demonstrate conduct conforming to a set of values and accepted standards.
• Judgment - The ability to formulate a sound decision using the available information.
• Communication, Oral - Ability to communicate effectively with others using the spoken word.
• Communication, Written - Ability to communicate in writing clearly and concisely.
• Problem Solving - Ability to find a solution for or to deal proactively with work-related problems.