This site uses cookies. To find out more, see our Cookies Policy

Customer Service Representative I in Orange at Prospect Medical Systems

Date Posted: 4/27/2018

Job Snapshot

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

Job Description

Customer Service Representative I

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.

This position is responsible for answering 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 other team members.  

Job Responsibilities/Duties

  • Assist customers in person (walk-ins) 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. The monthly expectation is to perform at a quality level of 85%. The daily expectation is to answer a minimum of 64 calls per day (inbound). Prompt response to incoming telephone calls will contribute to a consistent abandonment rate of 3% or less. The monthly expectation is to not exceed 40 unanswered calls per month.
  • Thorough documentation of telephone call conversation to include details and action taken. Every new telephone call must generate a new documentation record in our company system. Every follow-up call must be documented in existing documentation record. The monthly expectation is to produce a quality level of 85%. The call:documentation record ratio should be at 100%. All open / on-hold documentation records must be resolved and closed within 30 calendar days.
  • Follow up on open/on-hold issues. Respond to emails / voicemails within 24 hours providing follow up to issues.
  • Participate in trainings. Periodic job knowledge and subject matter testing. Health Plan contracting, Benefits, Rules and Regulations. A passing grade of 85% is expected.
  • Notify Supervisor of recurring issues and trends.
  • Active support of company initiatives and miscellaneous/special projects as assigned. The monthly expectation is to collect a minimum of ten (10) customer email addresses.  


Minimum Education: High school diploma or equivalent.

Minimum Experience: A minimum of two years of customer service experience in a call center environment required. Within a health care setting preferred. Minimum typing speed of forty (40) words per minute. Knowledge of IPA operations in a health care setting preferred. Knowledge and experience of claims , eligibility, and referrals preferred. Must be proficient in Microsoft Office navigation, Excel, and Word. EZCap and/or IDX knowledge a plus.

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

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.

EEOC is the Law:

Keywords: Customer Service Representative I..


  1. Sales Jobs
  2. Customer Service Jobs