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Customer Service Representative I (2796)

CaliforniaChoice · Centralia, WA

Purpose of Position: The Customer Service Representative I handles calls from customers to resolve, educate, follow-up and respond to questions regarding California Choice/Choice Builder plan administration and procedures groups, members, brokers and general agencies. Essential Functions: • Understanding of company policies and procedures as they apply to California Choice/Choice Builder plans. • Answers questions by telephone from groups regarding new hires, billings, rates, supplies, administrative procedures, etc. • Educates, via telephone, employees/dependents regarding PCP's, ID cards, RX problems, administrative procedures, dependent coverage, address changes, etc. • Follows-up on calls and emails from brokers regarding problems that their groups are experiencing with providers. • Ability to interact with brokers, general agents and sales representatives on a daily basis and must be able to answer questions regarding California Choice processes. • Responds to calls from providers to confirm eligibility and benefits. • Verifies enrollments and resolves issues with carriers. • Expedites processing of members enrollment with carrier if urgent services are needed. • Review and submit appeal requests from groups. • Review /Audit group billing and explain to clients in clear and accurate manner. • Document calls in call tracking system. • Departmental standard requires each Customer Service Representative to provide Service of Unequalled Excellence to all callers by maintaining an average of 90% or greater on Call Reviews. • Answer at least 100% of the daily call volume average. • Provide clear and explicit documentation while maintaining percentage at a level of 90% or higher daily. • Make busy time of 20 minutes or less per day. • Meet department standards for quality and quantity of work. • Meet department and team standards for turnaround times. • Adhere to all HIPAA (Health Insurance Portability and Accountability Act) and PHI (Personal Health Information) guidelines. • On-site regular attendance and punctuality are essential functions of the job. • Performs other business tasks or functions as assigned. Knowledge, Skills & Abilities Required: • At least two (2) years of customer service experience preferred. • Knowledge of the health insurance industry and customer service experience preferred. • Ability to handle irate customers in a courteous, patient, calm and positive manner while maintaining a high quality and quantity of work. • Experience in handling high call volume. • CA Life & Health license required. If successful applicant does not have insurance license, it is required to obtain one within six (6) months of date of hire. • Must have excellent verbal and written communication skills, especially under pressure. • Must be computer literate in Microsoft Word, Excel and Outlook. Accurate data entry skills a must. Typing at 55 WPM or more. • Must be able to work in a fast-paced environment where deadlines are a priority and handling multiple assignments simultaneously. • Problem Solving Skills required. • Must have a proficient knowledge of the English language. • Proficient knowledge of the Spanish language is a plus. If hired as a Bilingual representative, Language Assistance Certification is required every two (2) years. Additional Competencies: Action Oriented, Approachability, Customer Focus, Humor, Listening, Patience, Self-Knowledge, Technical Learning, Time Management, Written Communication In addition to the KSAs and Additional Competencies listed above, there are more competencies related to this position. Please refer to the Individual Contributor - Associate competency addendum. Educational Requirements: • High school diploma or equivalent required. Physical Requirements: Must be able to sit for extended periods of time and occasional standing and walking. Must have adequate hearing for phone work. Vision requirements include close vision and the ability to adjust focus. Must be able to communicate effectively in English. Must be able to use a keyboard and other office equipment. Ability to lift up to 10 pounds occasionally.

Remote Position in Boston, MA Explore opportunities with Atrius Health, part of the Optum family of businesses. We're an innovative health care leader and multi-specialty group practice, delivering an effective, connected system of care for adult and pediatric patients at 28 practice locations in eastern Massachusetts. Our entire team of providers (physicians, PA/NPs and ancillary clinicians) works collaboratively with a value-based philosophy within our group practice as well as with hospitals, rehab and nursing facilities. Be part of our vision to transform care and improve livesby building trust, understanding and shared decision-making with every patient. Join us and discover the meaning behind Caring. Connecting. Growing together. This position is full time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of Sunday, 7:30 am to 4:00 pm; Monday - Thursday 8:00 am - 4:30 pm. We offer 4 weeks of paid training. The hours during training will be 8:00 am - 4:30 pm, Monday - Friday. Training will be conducted onsite. Primary Responsibilities • Screens all incoming patient inquires (through phone, online/medical record message, or other means) to determine whether those inquiries can be appropriately handled by the Patient Service Representative or if they need to be directed to other team members • Courteous, friendly, problem solver with customer service, patient focused communication • Resolves issues in areas involving patient satisfaction, patient flow, and compliance with procedures and guidelines. Advocates for patients as appropriate • Participates in resolving operational difficulties and communicates with supervisor regarding department issues and problems as necessary • Resolves patient issues and ensures satisfaction. May refer difficult or highly complex phone calls and issues to higher level staff • Initiates requests for forms, letters, medication renewals, referrals, prior authorizations, and any other administrative needs submitted by patients and answers any corresponding questions. Understands all documents and processes • Reviews and facilitates the updating of missing /outdated information in the patient record, such as demographics, primary care physician selection, and insurance • Develops and maintains effective and efficient communication with the patient, interdisciplinary team, department staff, providers, and other agencies • Reviews department appointment schedules to ensure that clinic utilization is optimized and effectively supports the needs of the clinics as well as the needs of the patients • Assists with basic data collection activities, ensuring data is properly collected and accurate (e.g. no show reports, telephone statistics) • Participates in problem solving activities, focusing on productivity and quality. Works with supervisors to ensure continuous improvement of the department • Participates in special projects and ongoing programs unique to the department You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications • High School Diploma / GED OR equivalent work experience • Must be 18 years of age OR older • 1+ years of customer service experience • Electronic medical record (EMR) experience and/or aptitude to master the EMR based on other technology experience • Experience booking, rescheduling, and canceling appointments; and verifying patient eligibility using digital scheduling platforms. • Proficient in Microsoft Outlook, Microsoft Teams, Microsoft Word, and Microsoft Excel for communication, scheduling coordination, reporting, and internal collaboration. • Ability to work full time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of Sunday, 7:30 am to 4:00 pm; Monday - Thursday 8:00 am - 4:30 pm. Preferred Qualifications • 1+ years of experience working in a clinical setting • Working knowledge of patient related documents Telecommuting Requirements • Reside within commutable distance to the office at 147 Milk St., Boston, MA 2109 • Ability to keep all company sensitive documents secure (if applicable) • Required to have a dedicated work area established that is separated from other living areas and provides information privacy. • Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service. Soft Skills • Good time management skills • Well organized • Ability to problem solve • Ability to multi-task • Strong communication skills • Strong attention to detail *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The hourly pay for this role will range from $16.15 - $28.80 per hour based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. OptumCare is an Equal Employment Opportunity employer and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status. OptumCare is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Overview Answer with Care. Guide with Compassion. Support Every Step. We are seeking a dedicated Telephonic Triage RN to join our clinical call center team. This position is responsible for providing high-quality triage and nursing support over the phone for hospice patients and families during after-hours, holidays, and peak volume times. If you're an experienced, compassionate RN with strong clinical judgment and excellent communication skills, we invite you to bring your expertise home-literally. About the Role: The Telephonic Triage Nurse provides timely, expert guidance and support over the phone to hospice patients and families. This critical nursing role includes assessing symptoms, prioritizing calls, managing urgent care needs, and determining when an in-person visit is necessary. Key Responsibilities: • Receive and respond to calls for assigned hospice service areas • Prioritize urgent needs and assess callers' symptoms to guide care decisions • Assign on-call staff or provide treatment guidance per Plan of Care • Provide education, emotional support, and continuity of care • Collaborate with the interdisciplinary team to manage symptoms and avoid crises • Document all calls accurately in electronic medical record systems • Promote patient/family choices and quality of life at end of life • Participate in Quality Assessment and Performance Improvement programs • Maintain professional and compassionate communication with all stakeholders • Provide triage coverage for multi-state/multi-agency network About You Qualifications: • Graduate of an accredited nursing program • Current Registered Nurse (RN) license in a NLC Compact State • Three (3) years of clinical nursing experience • At least two (2) years of experience in hospice, oncology, long-term care, or home health • Bachelor's degree in nursing (BSN) preferred • Prior experience in telephone triage strongly preferred • Proficiency in EMR systems and Microsoft Office Suite • Current CPR certification, valid driver's license, and automobile insurance Work From Home Requirements: • Reliable high-speed internet (minimum 10 MBPS download / 5 MBPS upload) • Dedicated, quiet workspace • Comfortable wearing a headset up to 12 hours • Ability to navigate multiple computer screens (dual monitors + laptop) • Ability to report to nearest Gentiva branch if needed due to equipment issues Skills and Traits for Success: • Deep knowledge of hospice care and end-of-life needs • Strong patient assessment and communication skills • Ability to remain calm, clear, and compassionate in emotional or urgent situations • Adaptable, dependable, and solutions-focused • Strong documentation and time management capabilities • Sensitivity to diverse backgrounds and experiences We Offer Benefits for All Associates (Full-Time, Part-Time & Per Diem): • Competitive Pay • 401(k) with Company Match • Career Advancement Opportunities • National & Local Recognition Programs • Teammate Assistance Fund Additional Full-Time Benefits: • Medical, Dental, Vision Insurance • Mileage Reimbursement or Fleet Vehicle Program • Generous Paid Time Off + 7 Paid Holidays • Wellness Programs (Telemedicine, Diabetes Management, Joint & Spine Concierge Care) • Education Support & Tuition Assistance (ASN to BSN, BSN to MSN) • Free Continuing Education Units (CEUs) • Company-paid Life & Long-Term Disability Insurance • Voluntary Benefits (Pet, Critical Illness, Accident, LTC) Ready to support patients when it matters most? Apply now and bring your nursing skills home. Make every call count. Legalese • This is a safety-sensitive position • Employee must meet minimum requirements to be eligible for benefits • Where applicable, employee must meet state specific requirements • We are proud to be an EEO employer • We maintain a drug-free workplace Location Gentiva Hospice Our Company At Gentiva, it is our privilege to offer compassionate care in the comfort of wherever our patients call home. We are a national leader in hospice care, palliative care, home health care, and advanced illness management, with nearly 600 locations and thousands of dedicated clinicians across 38 states. Our place is by the side of those who need us - from helping people recover from illness, injury, or surgery in the comfort of their homes to guiding patients and their families through the physical, emotional, and spiritual effects of a serious illness or terminal diagnosis. Our nationwide reach is powered by a family of trusted brands that include: • Hospice care: Gentiva Hospice, Emerald Coast Hospice Care, Heartland Hospice, Hospice Plus, New Century Hospice, Regency SouthernCare, SouthernCare Hospice Services, SouthernCare New Beacon • Palliative care: Empatia Palliative Care, Emerald Coast Palliative Care • Home health care: Heartland Home Health • Advanced illness management: Illumia Health With corporate headquarters in Atlanta, Georgia, and providers delivering care across the U.S., we are proud to offer rewarding careers in a collaborative environment where inspiring achievements are recognized - and kindness is celebrated.

School Nurse (LPN)

Phaxis · Centralia, WA

At Navra, we believe your career is more than a job, it's a calling. As a boutique staffing firm, we take the time to understand your goals and connect you with roles that sharpen your skills, expand your impact, and reinforce the passion that brought you to education. As a School Nurse (LPN) in West Chicago, IL, your days will Include: • Provide direct nursing care and first aid to students for illnesses, injuries, and medical emergencies during the school day. • Administer prescribed medications and treatments in accordance with physician orders, district policies, and state regulations. • Monitor and manage students with chronic health conditions such as diabetes, asthma, seizure disorders, allergies, and other medical needs. • Maintain accurate student health records, medication logs, and required documentation while ensuring confidentiality. • Collaborate with teachers, administrators, parents/guardians, and healthcare providers to support students' health and educational success. • Respond to medical emergencies and implement appropriate emergency care procedures. • Promote a safe and healthy school environment through health education, illness prevention, and infection control practices. • Assist in developing and implementing Individualized Healthcare Plans (IHPs), Emergency Action Plans (EAPs), and support IEPs or 504 Plans as applicable. • Perform health screenings and assist with state-required health compliance activities as assigned by the district. • Educate students and staff on health-related topics, medication safety, and wellness initiatives. • Ensure compliance with Illinois State Board of Education (ISBE), Illinois Department of Public Health (IDPH), and district health policies. Job Details • Position: Contract (option to renew) in a school setting • Hours: Full-time (Monday - Friday) • Caseload: Providing general healthcare services in 1 elementary school building, K-5th grade Successful Candidates Possess • Graduate of an accredited Practical Nursing (LPN) program. • Current, active Illinois Licensed Practical Nurse (LPN) license in good standing, issued by the Illinois Department of Financial and Professional Regulation (IDFPR). • Current Basic Life Support (BLS)/CPR certification (or ability to obtain prior to the start of employment). • Previous experience in pediatrics, school nursing, family practice, public health, or a related clinical setting is preferred but not required. • Knowledge of medication administration, emergency response procedures, infection control, and student health documentation. • Ability to provide direct nursing care and administer medications under the supervision or direction of a Registered Nurse (RN) or other authorized healthcare provider, in accordance with Illinois law and district policy. • Strong communication, interpersonal, organizational, and documentation skills. • Ability to collaborate effectively with students, families, teachers, administrators, and multidisciplinary teams. • Must successfully complete all district-required background checks, fingerprinting, and employment clearances prior to employment. • The ability to work in the U.S. without a sponsor • Note: new graduates are welcome to apply Why Navra? • Comprehensive Benefits: Medical, dental, and vision insurance with year-round coverage options available for eligible contracted staff. • Supportive School Environment: Receive ongoing support from both the Navra team and school faculty, ensuring you always have a strong network behind you. • Professional Growth: Access continuous training, professional development opportunities, and career advancement resources. • Additional Perks: • Weekly pay • Licensure reimbursement (where applicable) • Employee referral bonus program At Navra, we believe great schools start with great people. As a boutique education staffing firm with more than 20 years of experience serving school districts nationwide, we specialize exclusively in connecting passionate school-based professionals with meaningful opportunities. When you work with Navra, you're more than just a placement, you become part of a team that is committed to your success. From your first conversation through the duration of your assignment, you'll have a dedicated support team advocating for you every step of the way. We're proud to build lasting relationships, support rewarding careers, and help make a difference in the lives of students every day. Reach out to Rachel Oliveri for more information! (646) 307-8964 (direct) or email ROliveri@navraedu.com