CareAdvantage Navigator (Bilingual Chinese)

Health Plan of San Mateo • South San Francisco, CA

1d • $27 - $34

About The Position

Act as the primary point of contact for members of CareAdvantage D-SNP and assist members with all aspects of plan benefits.

Requirements

• Equivalent to a high school diploma or GED required.
• Two (2) to three (3) years’ experience performing customer service preferably in a health plan environment.
• Previous experience working with seniors or people with disabilities and/in a medically related field such as medical assisting.
• Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access, and PowerPoint.
• Customer service principles and practices.
• Work cooperatively with others.
• Work as part of a team and support team decisions.
• Communicate effectively, both verbally and in writing.
• Adapt to changes in requirements/priorities for daily and specialized tasks.
• Demonstrate excellent oral and written communication skills with various audiences and individuals of diverse backgrounds.
• Perform problem research, use analytical skills, and effectively influence positive outcomes.
• Develop and maintain strong professional relationships with a diverse range of people.
• Utilize a personal computer, including the range of Microsoft Office products (Word, Excel, PowerPoint, Access, and Outlook).

Nice To Haves

• Bilingual skills in Spanish, Tagalog, Mandarin, Cantonese, or Russian.
• Health Insurance programs preferred.

Responsibilities

• Provide customer service to CareAdvantage members primarily on the phone.
• Answer member questions about CareAdvantage health and prescription drug benefits, eligibility, and provider network.
• Make New Member Welcome Calls.
• Resolve problems that members have accessing CareAdvantage-covered services, including but not limited to health care services and prescription medications.
• Ensure that assigned members retain CareAdvantage enrollment by investigating and contacting members and partnering agencies.
• Clearly document any member’s complaints, including grievances and appeals.
• Follow through with proactive solutions to resolve member issues.
• Prepare and submit requests for services made directly by a member to HPSM Health Services.
• Prepare and submit member requests for continuity of care with non-contracted providers to the Provider Services Department.
• Refer members to appropriate community partner agencies depending on specific circumstances including but not limited to: Behavioral Health and Recovery Services, Aging and Adult Services, Legal Aid and/or HICAP when appropriate.
• Relay pertinent health information to HPSM clinical staff to facilitate care coordination and/or receipt of medical services including prescriptions.
• Participate in and professionally represent HPSM at health fairs, community partnerships, meetings, committees, and coalitions as requested by the Manager or Supervisor.
• Perform other duties as assigned.

Benefits

• HPSM-paid premiums for employees’ medical, dental and vision coverage (employee pays 10% of each dependent’s premiums)
• Fully paid life, AD&D and LTD insurance
• Retirement plan (HPSM contributes the equivalent of 10% annual compensation)
• 12 paid holidays a year, 12 paid sick days a year and paid vacation starting at 16 days a year
• Tuition reimbursement plan.
• Employee wellness program

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED