Job Description
Company Overview: Sunshine Enterprise is an industry-leading Staffing and Recruitment Firm. Our clients are fortune 500 companies, high growth start-up companies, government, and private equity firms, and lead professional services firms. As a leading force in the business landscape, we take pride in bringing together great people and great organizations by fostering a work environment that values creativity, diversity, and growth. If you're ready to embark on a rewarding career journey with a company that prioritizes its employees, explore our current job opportunities below.
Job Summary
The Customer Service Representative is the first line of contact for members and providers and will assist them with questions related to the Medi-Cal programs for Orange County. The incumbent resolves member inquiries and complaints fairly and effectively. The incumbent provides information regarding eligibility, enrollment, benefits, and services to eligible members and providers.
**This is an on-site position.**
Duration: up to 6 months
Position Responsibilities

• Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• Maintains departmental productivity and quality standards.
• Follows through on and completes all member and provider inquiries or requests during the original member and provider interaction.
• Serves as a resource for other team members.
• Assists the team in carrying out department responsibilities and collaborates with others to support short and long-term goals/priorities for the department.
• Addresses member and provider inquiries, questions and concerns in all areas including eligibility, enrollment, claims or authorization status, benefit interpretation and referrals/authorizations for medical care in-person or telephonically.
• Enters accurate and complete documentation into internal application systems regarding all concerns and/or inquiries from the member and provider interaction.
• Communicates, builds and maintains internal and external relationships by prompt and accurate service delivery.
• Identifies and communicates challenges that might arise with the use of professional judgment while adhering to departmental policies and procedures.
• Completes other projects and duties as assigned.

Possesses the Ability To:

• Establish and maintain effective working relationships with leadership and staff.
• Function efficiently and productively in a high-volume call center.
• Learn procedures and regulations governing member eligibility and the terminology and documents used while remaining knowledgeable of Health/Medi-Cal benefits and procedures.
• Hear and speak well enough to converse on the phone and in person.
• Understand and follow oral and written directions.
• Speak, understand, read and/or write a second language in addition to English may be required for some assignments.
• Communicate clearly and concisely, both orally and in writing.
• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems (e.g., Facets) to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Experience & Education

• High School diploma or equivalent required.
• 6 months of experience in a call center capacity required.
• 6 months of Medi-Cal/Medicaid or health services experience.
• Typing speed of 35 words per minute (WPM) required.
• An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.

Abilities to:

• Develop rapport and establish and maintain effective working relationships with leadership and staff and external contacts at all levels and with diverse backgrounds.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely, both orally and in writing.
• Work a flexible schedule; available to participate in evening and weekend events.
• Organize, be analytical, problem-solve and possess project management skills.
• Work in a fast-paced environment and in an efficient manner.
• Manage multiple projects and identify opportunities for internal and external collaboration.
• Motivate and lead multi-program teams and external committees/coalitions.
• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job-specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment

Physical Requirements (With or Without Accommodations) :
- Ability to visually read information from computer screens, forms and other printed materials and information.
- Ability to speak (enunciate) clearly in conversation and general communication.
- Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
- Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
- Lifting and moving objects, patients and/or equipment 10 to 25 pounds
SUNSHINE ENTERPRISE USA LLC is an Equal Opportunity Employer and does not discriminate on the basis of race or ethnicity, religion, sex, national origin, age, veteran disability or genetic information or any other reason prohibited by law in employment.