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Customer Care Representative – Day Shift
Sharp HealthCareCustomer Care Representative supporting members of Sharp Health Plan, a San Diego healthcare system. Resolving coverage, claims, billing, enrollment, and provider-network questions through phone and digital systems.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates strong communication and interpersonal skills while effectively managing customer inquiries and concerns. Proficient in utilizing IDX, MedAccess, Salesforce, and related systems to verify eligibility, process payments, and ensure compliance with regulatory requirements.
Highest-signal resume keywords
Customer Call Center ExperienceIDX ProficiencySalesforce ProficiencyMedical Office CertificationBilingual Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Basic Computer SkillsWriting SkillsKnowledge of Plan BenefitsEligibility VerificationClaims ProcessingPayment ProcessingMedical TerminologyCustomer Satisfaction AssessmentOperational Problem SolvingRegulatory Compliance
Soft Skills
Interpersonal SkillsMature JudgmentEffective ParticipationCollaboration
Tools & Technologies
IDXMedAccessSalesforce
Certifications & Qualifications
Medical Office Certification
Industry Keywords
Health Maintenance OrganizationsDMHCCMSNCQACustomer Care Activities
About the role
Key responsibilities & impact- Communicate directly and promptly with Plan members, potential members, providers, employer groups, brokers, internal departments, and external agencies
- Provide information about Plan products, premiums, benefits, policies, and procedures
- Research and resolve customer concerns accurately
- Document calls and member concerns, complaints, and appeals
- Verify eligibility, enrollment, benefits, claims, authorizations, premiums, and PCP assignments using IDX, MedAccess, Salesforce, and related systems
- Add and update member information and generate or retrieve member documents
- Answer inquiries about benefits, referrals, PCP changes, ID cards, premium and subsidy amounts, COBRA, and Cal-COBRA procedures
- Assist members with coverage understanding, enrollment materials, provider-network services, premium and billing questions
- Process ACH and credit-card payments by phone
- Collaborate with internal departments, healthcare providers, vendors, employers, brokers, and other customers
- Participate in special projects, work groups, proposals, audits, and departmental backup support
- Identify and recommend solutions to operational problems
- Comply with DMHC, CMS, NCQA, regulatory, and accreditation requirements
- Work on assigned projects including member orientation, billing reminders, member education, claims investigation, pharmacy authorizations, appeals, and reimbursement requests
Requirements
What you’ll need- High school diploma or equivalent
- Minimum of six months’ experience as a Customer Call Center Representative
- Basic computer and writing skills
- Demonstrated knowledge of Plan benefits, policies, and procedures
- Knowledge of health maintenance organizations, performance management, and customer satisfaction assessment and delivery
- Mature and sound judgment
- Superior interpersonal skills
- Ability to effectively participate in Customer Care activities
- Bilingual skills preferred but not required
- Medical office certification, including medical terminology, preferred
- Must meet department scorecard, behavior, attendance, and knowledge-assessment standards
Benefits
Comp & perks- 🌐 Worldwide ❌ Jobs You've Hidden ⭐️ Saved Jobs ✅ Applied Jobs ✉️ Email Alerts 👤 Account Sharp HealthCare Website LinkedIn All Job Openings 10,000+ employees Founded 1946 🏥 Healthcare 🧘 Wellness Healthcare
- Nursing
- Wellness Sharp HealthCare is a healthcare organization dedicated to providing high-quality medical services to patients and families. With a commitment to innovation, safety, and excellence, Sharp HealthCare offers a range of career opportunities in nursing, clinical support, administration, and various medical specialties. The organization emphasizes a collaborative work environment and is recognized for its nursing excellence, aiming to advance the science of medicine alongside compassionate patient care. Customer Care Representative – Day Shift 🔥 0 minutes ago 🏄 California – Remote 💵 $25 - $35 / hour ⏰ Full Time 🟢 Junior 💝 Customer Support 🚫👨🎓 No degree required Apply Now Customize resume + cover letter Report problem ☆ Save ☑️ Mark as applied ❌ Hide 📋 Description
- Communicate directly and promptly with Plan members, potential members, providers, employer groups, brokers, internal departments, and external agencies
- Provide information about Plan products, premiums, benefits, policies, and procedures
- Research and resolve customer concerns accurately
- Document calls and member concerns, complaints, and appeals
- Verify eligibility, enrollment, benefits, claims, authorizations, premiums, and PCP assignments using IDX, MedAccess, Salesforce, and related systems
- Add and update member information and generate or retrieve member documents
- Answer inquiries about benefits, referrals, PCP changes, ID cards, premium and subsidy amounts, COBRA, and Cal-COBRA procedures
- Assist members with coverage understanding, enrollment materials, provider-network services, premium and billing questions
- Process ACH and credit-card payments by phone
- Collaborate with internal departments, healthcare providers, vendors, employers, brokers, and other customers
- Participate in special projects, work groups, proposals, audits, and departmental backup support
- Identify and recommend solutions to operational problems
- Comply with DMHC, CMS, NCQA, regulatory, and accreditation requirements
- Work on assigned projects including member orientation, billing reminders, member education, claims investigation, pharmacy authorizations, appeals, and reimbursement requests 🎯 Requirements
- High school diploma or equivalent
- Minimum of six months’ experience as a Customer Call Center Representative
- Basic computer and writing skills
- Demonstrated knowledge of Plan benefits, policies, and procedures
- Knowledge of health maintenance organizations, performance management, and customer satisfaction assessment and delivery
- Mature and sound judgment
- Superior interpersonal skills
- Ability to effectively participate in Customer Care activities
- Bilingual skills preferred but not required
- Medical office certification, including medical terminology, preferred
- Must meet department scorecard, behavior, attendance, and knowledge-assessment standards Apply Now 📊 Check your resume score for this job Improve your chances of getting an interview by checking your resume score before you apply. Check Resume Score Similar Jobs Seasonal Support Specialist 🔥 29 minutes ago H&R Block 10,000+ employees 💸 Finance 👥 B2C 🤝 B2B Website LinkedIn All Job Openings H&R Block Support Specialist providing remote phone, email, and chat support for enterprise technology users. Resolving incidents, remotely troubleshooting desktops, and tracking customer requests end to end. 🇺🇸 United States – Remote 💵 $18 - $27 / hour ⏰ Full Time 🟢 Junior 💝 Customer Support 🚫👨🎓 No degree required Vaccine Delivery and Support Specialist 🔥 53 minutes ago Zoetis 10,000+ employees 🏥 Healthcare 🍽️ Food & Beverage 🏭 Manufacturing Website LinkedIn All Job Openings Zoetis poultry vaccine specialist coordinating frozen vaccine delivery, inventory, routes, and customer application support in Pennsylvania. Training customers and auditing safe handling and spray application practices. 🇺🇸 United States – Remote ⏰ Full Time 🟢 Junior 🟡 Mid-level 💝 Customer Support 🚫👨🎓 No degree required 🦅 H1B Visa Sponsor Customer Service Representative 🔥 2 hours ago LifeMD 201 - 500 🏥 Healthcare 💼 Consulting 📣 Marketing Website LinkedIn All Job Openings Customer Service Representative supporting LifeMD’s virtual healthcare patients. Answering calls, resolving inquiries, maintaining accounts, and coordinating medical scheduling. 🇺🇸 United States – Remote 💵 $22 / hour ⏰ Full Time 🟢 Junior 🟡 Mid-level 💝 Customer Support 🚫👨🎓 No degree required 🦅 H1B Visa Sponsor Sales Support Representative 🔥 3 hours ago Baxter International Inc. 10,000+ employees 🏥 Healthcare 🏭 Manufacturing ⚕️ Healthcare Insurance Website LinkedIn All Job Openings Baxter Sales Support Representative supporting Infusion Therapy customers across five U.S. states. Delivering customer training, field sales support, order assistance, presentations, and Pump Fair coordination. 🇺🇸 United States – Remote 💵 $48k - $66k / year 💰 Grant on 2021-04 ⏰ Full Time 🟢 Junior 🟡 Mid-level 💝 Customer Support 🚫👨🎓 No degree required Customer Support Agent 🔥 5 hours ago Sumsub 501 - 1000 💼 Consulting ⚖️ Legal 📦 Logistics Website LinkedIn All Job Openings Customer Support Operator assisting users of Sumsub’s AI-powered identity verification, fraud prevention, and compliance platform. Resolving chat inquiries, documenting interactions, and escalating complex issues. 🇺🇸 United States – Remote 💰 $30M Series B - Sumsub on 2022-12 ⏰ Full Time 🟢 Junior 💝 Customer Support 🚫👨🎓 No degree required View More Customer Support Jobs 🌐 Worldwide Built by Lior Neu-ner. I'd love to hear your feedback — Get in touch via DM or support@remoterocketship.com Search Search Jobs by country Search jobs by city Search jobs by job title Search entry-level jobs Search junior-level jobs Search senior-level jobs Search jobs by tech stack Search jobs by contract type Search remote internships Search remote part-time jobs Remote jobs Anywhere in the World Companies Hiring Anywhere in the World Companies Hiring Sales People Anywhere in the World Companies Hiring Software Engineers Anywhere in the World Resources Advice Tips for finding remote jobs Interview questions and answers Resume examples Cover letter examples Post a job Affiliates About us Is Remote Rocketship legit? Privacy policy Terms of service Job board SEO course Remote Job Search MasterClass AI Apply Copilot OpenClaw job finder Find jobs using your resume Jobs by Country Remote jobs anywhere in the world (Worldwide remote jobs) Remote jobs United States Remote jobs Australia Remote jobs Brazil Remote jobs Canada Remote jobs France Remote jobs Ireland Remote jobs Germany Remote jobs Netherlands Remote jobs Spain Remote jobs UK Popular Jobs Remote data analyst jobs Remote customer support jobs Remote executive assistant jobs Remote marketing jobs Remote product designer jobs Remote product manager jobs Remote project manager jobs Remote recruiter jobs Remote sales jobs Remote software engineer jobs Jobs by Type Remote full-time jobs Remote part-time jobs Remote contract jobs Remote internship jobs Remote entry-level jobs Remote jobs with no experience required Remote junior jobs (1-3 years of experience) Digital nomad jobs Remote jobs with no degree required Freelance remote jobs Temporary remote jobs Remote jobs hiring now Stay at home mom jobs