Overview

CalOptima Health is a public health insurance agency based in Orange County, California. It serves low-income individuals and families, primarily through Medi-Cal, California's Medicaid program. CalOptima provides comprehensive health care coverage, including medical, dental, vision, and mental health services, to its members. The organization focuses on improving health outcomes for its diverse population by offering access to quality care, managing health plans, and coordinating services with a network of providers. CalOptima is known for its commitment to community health and serving vulnerable populations.

Project Scope

CalOptima Health was seeking a vendor to deliver top-notch customer services, specifically seeking a highly motivated and experienced TEMP - Customer Service Representative (Non-Bilingual) to join their team. The role required a CSR to serve as the first point of contact for CalOptima Health’s members and providers, assisting them with inquiries and complaints related to the Medi-Cal programs in Orange County. The CSR was expected to provide accurate information regarding eligibility, enrollment, benefits, and services to eligible members and providers. V Group successfully fulfilled this requirement, delivering the needed customer service expertise to support CalOptima Health's mission.

Solution

V Group Inc. has provided a comprehensive solution to CalOptima Health by fulfilling all the responsibilities. We successfully provided exceptional Program Support, dedicating 80% of our efforts to maintaining high standards of customer service, quality, and consistency. Our team addressed all member and provider inquiries promptly and effectively, serving as a valuable resource for our clients. We also excelled in Administrative Support, allocating 15% of our resources to assist with departmental tasks, manage inquiries related to eligibility, enrolment, claims, and benefits, and ensure precise documentation in our internal systems. Our commitment extended to building and sustaining strong internal and external relationships, addressing potential challenges with professionalism while adhering to our policies. Additionally, we completed other assigned projects and duties, contributing 5% of our efforts to support our clients' evolving needs. So, V Group successfully delivered the skilled customer service CalOptima Health needed to support their mission.  

Technology

• Customer Relationship Management (CRM) Systems
• Healthcare Information Systems
• Microsoft Office Suite
• Typing and Data Entry Tools