Job Description
We are looking for a bilingual Spanish/English Customer Service Representative to support members in a fast-paced healthcare environment in Westminster, California. This is a Contract position focused on delivering responsive service, explaining health plan information clearly, and helping callers resolve concerns with professionalism and empathy. The ideal candidate brings prior call center or customer support experience, strong communication skills, and the ability to navigate member questions while following healthcare guidelines and internal procedures.
Responsibilities:
• Respond to inbound member inquiries and evaluate each situation to provide accurate, timely, and appropriate assistance.
• Explain coverage details, benefit options, and plan-related information to members, family members, providers, and caregivers in a clear and helpful manner.
• Investigate service concerns by identifying root causes, outlining next steps, and ensuring members receive thorough follow-up until issues are addressed.
• Route complex or sensitive matters to leadership or the appropriate internal teams when additional review or action is needed.
• Support outbound outreach efforts and assigned calling campaigns designed to strengthen member engagement and retention.
• Record conversations, actions taken, and required forms accurately in designated systems while maintaining departmental documentation standards.
• Adhere to established workflows, job aids, and service procedures, while sharing process improvement ideas and reporting operational concerns through proper channels.
• Participate in team meetings, training sessions, and ongoing coaching to maintain service quality and support continuous improvement.
• Follow all applicable federal and state healthcare regulations, as well as company policies, in daily member service activities.
• Perform additional customer service and administrative tasks as needed to support department operations.
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