Bi-Lingual MCO/PCP (Spanish-English) Call Center Customer Service Representative

Duties and Responsibilities
o Responsible for assisting enrollees in selecting the most appropriate MCO and PCP, taking into account each individuals’
needs and location
o Answers questions and provides information and education on programs and services.
o Responds to requests, and/or takes actions on accounts or enrollment applications.
o Follows standard procedures to ensure consistency, accuracy, and meeting all quality assurance requirements
o Facilitates the conversation by soliciting needed information, clarifying responses, and addressing concerns.
o Manages customer inquiries with consistency, accuracy, and professionalism, displaying excellent customer service skills
and extensive technical program knowledge.
o Follows scripted dialogues to ensure quality and maintain high accuracy rates.
o Regular and predictable attendance required.
o Other duties as assigned.
Knowledge, Skills and Abilities
o Managing Work: Effectively managing time and resources to make sure that work is finished. Identifies more critical and
less critical activities and tasks. Uses time effectively
o Decision Making: Identifying and understanding issues; comparing information to make a choice; choosing a course of
action carefully and wisely; taking action. Recognize issues, problems, or opportunities, and determines whether action is
needed. Identifies the need for and collects information to better understand issues, problems, and opportunities.
o Communication: Clearly expressing information and ideas through a variety of ways; helping individuals understand and
retain the message. Organizes communication by clarifying the purpose and importance. Checks for understanding when
communicating.
o Contributing to Team Success: Actively participating as a member of a team to help the team complete goals. Makes
suggestions for achieving team goals. Demonstrates personal commitment to the team.
o Work Standards: Setting high standards of performance for self and others; taking responsibility and accountability for
successfully completing work. Establishes criteria and/or work procedures to achieve a high level of quality, productivity,
or service. Admits mistakes and refocuses efforts when appropriate.
o Customer Focus: Making customers and their needs a main focus. Developing and keeping valuable customer
relationships. Actively seeks information to understand customers' circumstances, problems, expectations, and needs.
Responds quickly to meet customer needs and resolves problems
Job Specification
o Skill/Knowledge: Has substantial understanding of the job and applies knowledge and skills to complete a wider range of
tasks.
o Job Complexity: Works on assignments that are moderately difficult, requiring judgment in resolving issues or in making
recommendations. Exhibits moderate program knowledge.
o Supervision Received: Normally receives little instruction on daily work, general instructions on newly introduced
assignments.

Required Education:
▪ High school diploma or equivalent

Required Experience:
▪ Two (2) years of customer service/call center
experience or equivalent.
▪ Experience working with special needs populations
and/or families of special needs children.
▪ Experience or training in a health care related field
▪ Experience or training related to health care
insurance, Medicaid, MCO/PCP selection, EPSDT
services, and any other health care programs or
similar programs administered in other states.
▪ Experience or training in the managed care
industry.
▪ Experience using a personal computer and software
programs and a TTY machine

Bi-Lingual - Spanish-English