Customer Service Representative Sr (OneCare) (Bilingual)

Customer Service Representative Sr (OneCare) (Bilingual)

Join us in this amazing opportunity. We are a mission-driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.

We are hoping you will join us as a Customer Service Representative Sr (OneCare) (Bilingual) and help shape the future of healthcare where you'll be an integral part of our CS - OneCare Customer Service team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. You will serve as a senior point of contact for OneCare members and providers and assist them with questions and / or complaints related to the OneCare plan services. You will provide information regarding eligibility, enrollment, benefits and services to OneCare eligible members and providers.

Your contributions to the team include :

• 95% - Program Support
• Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals / priorities for the department.
• Addresses member and provider inquiries, questions and concerns in all areas, including eligibility, enrollment, claims or authorization status, benefit interpretation and referrals / authorizations for medical care in-person or telephonically.
• Serves as a senior resource for other team members (i.e., solves complex challenges, answers uncommon questions and shares complex processes and procedures).
• Supports in the coordination of member's health care and social service needs both within and outside the medical group and CalOptima Health.
• Enters accurate and complete documentation into internal application systems regarding all concerns and / or inquiries from the member and provider interaction.
• Initiates referrals to both internal and external care management departments and other department / government or community agencies.
• Maintains departmental productivity and quality standards.
• Follows through and completes all member and provider inquiries or requests during the original member and provider interaction. Provides additional follow-up assistance as needed.
• 5% - Other
• Completes other projects and duties as assigned.

Do you have what the role requires?

High school diploma or equivalent PLUS 2 years of experience in customer / member service, including 1 year of call center capacity required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. Typing speed of 35 words per minute (WPM) required. Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese) required.

You'll stand out more if you possess the following :

1 year of Health Maintenance Organization (HMO), Medi-Cal / Medicaid and health services experience.

What the regulatory agencies need you to possess?

N / A

Your knowledge & abilities to bring to this role :

Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees / coalitions. Utilize computer and appropriate software (e.g., Microsoft Office : Word, Outlook, Excel, PowerPoint) and job specific applications / systems to produce correspondence, charts, spreadsheets, and / or other information applicable to the position assignment.

Your physical requirements (with or without accommodations) :

Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication / conversation / responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and / or equipment 10 to 25 pounds.

Ways we are here for you :

You'll enjoy competitive compensation for this role. Our current hiring range is : Pay Grade : 302 - $49,754 - $69,655 ($23.92 - $33.4880). The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors. This position is approved for Part Time, Full Telework (

CalPERS pension program and additional retirement packages.

Additional benefits and perks including :

Our work environment :

If located at the 500, 505 Building or a remote work location :

Work is typically indoors and sedentary and is subject to schedule changes and / or variable work hours, with travel as needed.

There are no harmful environmental conditions present for this job.

The noise level in this work environment is usually moderate.

If located at PACE :

Work is typically indoors in a clinical setting serving the frail and elderly.

There may be harmful or hazardous environmental conditions present for this job.

The noise level in this work environment is usually moderate to loud.

If located in the community :

Work is typically indoors and sedentary and is subject to schedule changes and / or variable work hours, with travel as needed.

Employee will occasionally work outdoors in varied temperatures.

There may be harmful or hazardous environmental conditions present for this job.

The noise level in this work environment is usually moderate to loud.

Why join us?

We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impact on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare.

What's your next step?

All applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is November 12, 2025 at 9 : 00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date.

Our commitment to you :

Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment