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Customer Service Representative, Sr

Wellcare - Cypress, CA

Customer Service Representative, Sr','1705393','!*!About WellCare: WellCare Health Plans, Inc. is a Fortune 500 company traded on the New York Stock Exchange (symbol: WCG). It provides managed care services targeted to government-sponsored health care programs, including Medicaid, Medicare, Prescription Drug Plans and the Health Insurance Marketplace. Headquartered in Tampa, Fla., WellCare offers a variety of health plans for families, children, and the aged, blind and disabled. The company serves approximately 4 million members and employs approximately 6,500 people nationwide as of Sept. 30, 2014. For more information about WellCare, please visit our website at or view our videos at All qualified applicants shall receive consideration for employment without regard to race, color, religion, sex, age forty (40) and over, disability, veteran status, or national origin.','!*!This position is for Easy Choice Health Plan Inc. in Cypress, CA, a WellCare Healthplans, Inc. company.

Responds to member and provider inquiries (phone, written or walk in) regarding all aspects of WellCare business, including claims and pharmacy, in a professional, timely, accurate and caring manner while consistently meeting all guidelines.  Serves in a limited leadership capacity as a subject-matter-expert and mentor.


Department: CA – Operations State

Reports to: Sr Mgr, State Operations

Location: 10803 Hope Street, Suite B, Cypress, CA 90630

Job Type: Hourly/Non-exempt


Essential Functions:

Responds to basic member, provider and other inquiries via telephone, correspondence or lobby walk-in while meeting all corporate guidelines and performance standards.

Acts as a primary contact for escalated calls and/or escalated issues in which special care is required to enhance WellCare relationships with members and providers.

Handles calls that require additional research and/or special handling including regulatory, congressional, trust, marketing, sales, executive office, Centers for Medicare and Medicare Services (CMS), etc.

Investigates problems of an unusual nature in the area of responsibility.  Presents proposed solutions in a clear and concise manner.

Acts as a liaison between internal departments on data gathering and problem solving.

Drives and supports WellCare initiatives at the team level by interacting with peers and other internal and external business partners while demonstrating a willingness to conform to WellCare policies and procedures.

Demonstrates appropriate customer-care skills such as empathy, active listening, courtesy, politeness, helpfulness, and other skills as identified.

Records, investigates and resolves customer complaints as detailed in the Grievance Procedure narrative.

Assist in the education of new members and in the re-education of existing members regarding health plan procedures.

Logs, tracks and follow-ups on all inquiries, utilizing on-line systems and procedures, according to the established guidelines.

Demonstrates expertise within all assigned LOB’s.  Handles calls for multiple LOB’s as assigned.    

Performs skills necessary to create a high-quality customer experience, as reflected through acceptable C-Sat scores, quality monitors and member feedback.

Acts as a Subject Matter Expert (SME).

Assists with other projects and duties as assigned.','!*!Education:  High School Diploma                       


1-2 years experience within a call center or customer service environment

Experience within a health care company preferred

Licenses/Certifications:  Customer service, quality, or training certifications (preferred)  

Special Skills (e.g. 2nd language): 

Strong written and verbal communication skills and an ability to work with people from diverse backgrounds

Ability to multi-task, good organizational and time management skills

Ability to act on feedback provided by showing ownership of his or her own development

Ability to read, analyze and interpret verbal and written instructions

Ability to write business correspondence

Ability to effectively present information and respond to questions from members

Ability to define problems, collect data, establish facts and draw valid conclusions

Seeks to build trust, respect and credibility with all partners through full, honest, consistent, and coordinated communication

Technical Skills/Requirements: 

Proficiency with Microsoft Outlook to easily and readily communicate with both internal and external contacts

Proficiency with Word and/or Excel sufficient to easily and readily manipulate data

#LI-MT1','US-CA-Cypress','10803 Hope Street','Suite B','Cypress','90630','','','No','No','Customer Service Representative, Sr'

9 days 14 hours ago



Customer Service Representative, Sr Wellcare - Cypress, CA, United States


Location: Cypress, CA

Company Profile:
WellCare Health Plans, Inc. focuses exclusively on providing government-sponsored managed care services, primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, to families, children, seniors and individuals with complex medical needs. The company served approximately 3.8 million members nationwide as of Sept. 30, 2015. For more information about WellCare, please review our website and view the company’s videos. WellCare has developed a full complement of expertise in three major areas of government-sponsored health care…. Medicaid, Medicare Advantage and Medicare Prescription Drug Plans. Leveraging our expertise for our members' benefit is a key part of the value we bring to our members. WellCare focuses on those members who are dually eligible for both Medicaid and Medicare. This is an area of specialization that many other health plans simply do not have. We are committed to continually improving the quality of care and service that we provide to our members. We help our members access the right care at the right time in the appropriate setting. For some members, this includes the use of coordinated care teams and community partnerships. And we’re focused on government customers and use a disciplined approach to ensure a competitive cost structure.