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Outbound Customer Service Representative - CSR

TotalMed Professional San Jose, CA
  • Expired: over a month ago. Applications are no longer accepted.

AY- $16-$18

HOURS- M-F 8am to 5pm

Contract- 3-6 months


Make outbound calls to close gaps in care for members and help them make appointment with PCPs


  • Reference current materials to answer escalated and complex inquiries from members and providers regarding claims, eligibility, covered benefits and authorization status matters
  • Provide assistance to members and/or providers regarding website registration and navigation
  • Educate members and/or providers on health plan initiatives Provide first call resolution working with appropriate internal/external resources, and ensure closure of all inquiries
  • Document all activities for quality and metrics reporting through the Customer Relationship Management (CRM) application
  • Process written customer correspondence and provide the appropriate level of follow-up in a timely manner
  • Research and identify processing inaccuracies in claim payments and route to the appropriate team for claim adjustment
  • Identify trends related to member and/or provider inquiries that may lead to policy or process improvements that support excellent customer service and impact quality and performance standards
  • Work with other departments on cross functional tasks and projects
  • Maintain performance and quality standards based on established call center metrics including turn-around times

TotalMed Professional

Why Work Here?

Great opportunity to enhance your career in the Managed Care Organization space!


San Jose, CA