Customer Solution Center Personal Care Connector I

　　Job Category: Customer Service

　　Department: Customer Solution Call Center

　　Location:

　　Los Angeles, CA, US, 90017

　　Position Type: Full Time

　　Requisition ID: 10646

　　Salary Range: $55,245.00 (Min.) - $69,045.00 (Mid.) - $82,867.00 (Max.)

　　Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.

　　Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

　　Job Summary

　　The Customer Solution Center Personal Care Connector (PCC) I will be assigned specific Cal MediConnect member assignments. This position is responsible for assisting with on-boarding care connection including, but not limited to benefit coordination, continuity of care, access to care, quality of care issues, member eligibility, assignment/disenrollment issues, and interpreting requests. The responsibilities of this position also includes in/outbound interactions with other departments/entities, internal and external, to identify and facilitate the coordination of the member needs. The PCC will perform various functions including answering calls, conducting outreach activities and performing various data entry functions. All interactions are to be documented in the system(s) of record.

　　Duties

　　Provide VIP service to assigned membership, to include benefit coordination, access to care, quality of care issues, member eligibility, assignment/disenrollment issues, interpreting requests, and anything of complex nature. Ensures timely follow through and documentation on all cases forwarded to other areas, internal and external. (45%)

　　Provides on-boarding care connection for assigned Cal MediConnect members while supporting entire membership. This includes but is not limited to Welcome Call and Health Risk Assessment (HRA), new member education and orientation, PCP assignment, and member materials. (15%)

　　Ownership of Continuity of Care (COC) process through internal and external department/ entities for coordination and timely follow- up with members on resolution. (15%)

　　Responds to member/internal staff/providers through in/outbound calls for all Lines of Business concerning benefits, eligibility, referrals, claims and all other issues following department policies and procedures. All interactions are to be documented in the system(s) of record. (15%)

　　Performs other duties as assigned. (10%)

　　Duties Continued

　　Education Required

　　High School Diploma/or High School Equivalency Certificate

　　Education Preferred

　　Associate's Degree

　　Experience

　　Required:

　　At least 0-2 years of customer service telephone experience in a healthcare environment.

　　Minimum of 0-2 years of experience of Medicare & Medicaid.

　　Demonstrated experienced in the Cal MediConnect line of business or alike dual programs.

　　Data entry experience with ability to type a minimum of 40 wpm.

　　Skills

　　Required:

　　Significant knowledge of both Medicare/ Medicaid and Medi-Cal.

　　Proficient knowledge in medical terminology.

　　Ability to answer a high volume of calls; previous atuomatic call distributor (ACD) experience preferred.

　　Good understanding of service to the disadvantaged population, seniors and or people with chronic conditions or disabilities.

　　Must be a quick learner, excellent team player and customer service oriented.

　　Preferred:

　　Bilingual in one of L.A. Care Health Plan’s threshold languages is highly desirable. English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese.

　　Licenses/Certifications Required

　　Licenses/Certifications Preferred

　　Required Training

　　Physical Requirements

　　Light

　　Additional Information

　　Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

　　L.A. Care offers a wide range of benefits including

　　Paid Time Off (PTO)

　　Tuition Reimbursement

　　Retirement Plans

　　Medical, Dental and Vision

　　Wellness Program

　　Volunteer Time Off (VTO)