Customer Service Representative III in Orange at Prospect Medical Systems

Date Posted: 8/15/2019

Job Snapshot

  • Employee Type:
  • Location:
    600 City Parkway West
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
  • Job ID:

Job Description

Customer Service Representative III

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

The Customer Service Representative III position is responsible to assist with walk-in members/providers and answer escalated telephone calls in a prompt, courteous,  professional manner and acting as a liaison between Prospect Medical/ProMed Healthcare and: members; contracted and non-contracted care providers, ancillary providers; health plans; billing companies; collection companies, to provide assistance and respond to service requests.  Representative is responsible for being a resource for department team members. 

Job Responsibilities/Duties

  • Assist customers and Customer Service representatives with escalated issues; in person (walk-ins) or on the telephone in a courteous, professional manner with inquiries, updates, changes related but not limited to claims, eligibility, referrals, PCP changes, billing, access, transportation and general coordination of care through thorough research in a timely manner.
  • 100% thorough documentation of every call.
  • Thoroughly verify HIPAA requirements to ensure account accuracy.
  • Follow-up and respond to external department on all open issues.
  • Actively support supervisors and supervisors’ needs as required.
  • Identify and support/quality training opportunities for staff.
  • Communicate recurring issues and trends to management.
  • All other duties assigned.  


Minimum Education:  High School Diploma or equivalent required. Bachelor’s Degree preferred.

Minimum Experience:  A minimum of four (4)years of customer service experience in a call center environment required. Within a health care setting preferred.  Knowledge and experience of claims , eligibility, and referrals preferred. Bilingual preferred.​ Knowledge of IPA operations in a health care setting required. Knowledge of HIPAA regulations required. Ability to make decisions in the absence of detailed instructions. Exceptional customer service and conflict resolution skills. Excellent written and verbal communication skills.  Ability to multi-task, prioritize, and work in a fast pace environment.

Req. Certification/Licensure:   None

Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:

  • Company 401K
  • Medical, dental, vision insurance
  • Paid time-off
  • Life insurance

Prospect Medical Systems has a zero-tolerance policy regarding the use of drugs and alcohol.  Our Company is committed to maintaining a productive, drug free workplace that keeps employees and patients safe from harm.  For this reason, we require applicants to pass a screening for drug use as a condition of employment.  This includes: alcohol, marijuana, cocaine, opiates and methamphetamines.

How to Apply

To apply for this role, or search our other openings, please visit  and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

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