Customer Service Lead /Auditor , Member Services

Position Summary: 

This position is responsible for routine audits on individual’s Customer Service representatives on Customer Service Module and REA/LEAD customers service case, responsible for training the Customer Service representatives and answers questions relating to eligibility, referrals, provider availability, claims status and department procedures. Handling escalated inquiries from members, Health Plans, providers and employer groups, to provide information and clarification on RMG services.

Essential Duties and Responsibilities include the following:

• Receives incoming calls involving multiple issues from members, Health Plans and providers maintain quality and productivity standards
• Conduct and maintain quality assurance progress reports, conduct Q&A reviews by listening to recorded calls and providing training and feedback as necessary
• Audit documentation for accuracy of the Customer Service module and REA/LEAD Customer Service Cases
• Audit Customer Service incident reports for RMG, LMG, GCMG and ADOC for timeliness
• Conduct weekly procedural training meetings with Customer Service representatives to address current issues that impact the CSC department, interact with leadership group to aid in overall staff development and training
• Attend daily and weekly meetings with supervisors and department manager and provide written status and progress reports.
• Researches and resolves routine and complex issues relating to services provided by RMG,LMG GCMG and ADOC. This can include eligibility updates, referral status, claim status, and general information.
• Trains new Customer Service employees and answers questions relating to eligibility, referrals, provider availability, claims status and department procedures
• Facilitates the processing of telephone appeals, inquiries or complaints, statement of concerns for the member by accurately and timely collection of information
• Work independently and make Auditor/Team Lead decisions when necessary.
• Handle a multitude of assignments and prioritize work in order to maintain workflow.
• Provide assistance and mentoring to other Customer Service representatives or personnel as needed.
• Ensure written and verbal communication with all levels of management, staff, vendors and property management or accurate and with good grammar.
• Maintain confidentiality with all information pertaining to the members medical information
• Have the required ability to operate well in a call center team environment as a team leader.
• Have a very strong knowledge of customer care techniques and processes.
• Documentation such as general reports on each team member’s performance and targets as well as ensuring that they exceed the targets
• A team leader has the responsibility to motivate and inspire once the peer’s team to surpass their potential as much as possible.

The pay range for this position at commencement of employment is expected to be between  $23- $25 per hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

Full Time Position Benefits:

The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

Health and Wellness:

• Employer-paid comprehensive medical, pharmacy, and dental for employees
• Vision insurance
• Zero co-payments for employed physician office visits
• Flexible Spending Account (FSA)
• Employer-Paid Life Insurance
• Employee Assistance Program (EAP)
• Behavioral Health Services

Savings and Retirement:

• 401k Retirement Savings Plan
• Income Protection Insurance

Other Benefits:

• Vacation Time
• Company celebrations
• Employee Assistance Program
• Employee Referral Bonus
• Tuition Reimbursement
• License Renewal CEU Cost Reimbursement Program
• Business-casual working environment
• Sick days
• Paid holidays
• Mileage

Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.

Education and / or Experience: 

• High School Graduate or equivalent required.
• 3 year experience in medical office, related field, including Customer Service duties
• Ability to deal responsibly with matters of a confidential nature.
• Ability to prioritize work in order to meet daily deadlines.
• Must have excellent communication skills, both verbal and written.
• Ability to read, write and understand the English language.
• Pleasant telephone manner.
• Working knowledge of MS Word.
• Working knowledge of MS Excel.
• Working knowledge Outlook (email & calendar)
• Working knowledge of Cisco phone system
• Ability to operate PC based software programs or automated data base management systems
• Thorough knowledge of company internal policies and procedures relating to service, medical management, eligibility and claims.
• Training experience in handling sensitive situations for members