Bilingual Korean Member Advocate - Healthcare

Paycom; Huntington Beach, Arcadia (CA, CA); Hybrid; USD 57,308,000 - 65,904,000; Full time

Job summary

Clever Care Health Plan is hiring a Member Advocate I to be the main point of contact for members, prospective members, providers, brokers and vendors. You will assist with benefits, eligibility, referrals, claims and other plan services while delivering superior customer service.

The role emphasizes accurate issue resolution, professionalism, and adherence to HIPAA guidelines, with a hybrid work arrangement and opportunities to contribute to community healthcare access.

Qualifications

• High School Diploma or equivalent required.
• Bachelor’s Degree or equivalent work experience preferred.
• Two (2) years Customer Service experience preferably in healthcare management and/or a call center setting.

Responsibilities

• Educates members, family, providers and caregivers regarding benefits and plan options.
• Accurately explains benefits and plan options in person, via email, fax, or telephonically.
• Provides follow-up with members by clarifying the customer’s issue, determining the cause, and identifying and explaining the solution. Escalates appropriate member issues to management or other departments as required.
• Provides follow-up with members by clarifying the customer’s issue, determining the cause, and identifying and explaining the solution. Escalates appropriate member issues to management or other departments as required.
• Participates in member calling projects as assigned by management to support the overall Clever Care goal of membership retention.
• Follows policies and procedures and job aids in order to maintain efficient and complaint operations; communicates suggestions for improvement and efficiencies to management; identifies and reports problems with workflows following proper departmental procedures; actively participates in departmental staff meetings and training sessions.
• Follows all appropriate Federal and State regulatory requirements and guidelines applicable to Clever Care Health Plan operations, as documented I company policies and procedures. Follows all HIPAA requirements.
• Documents transactions by completing applicable member forms and summarizing actions taken in appropriate computer system and following standards set by the department or by other authorized individuals.
• Ability to work in an environment where continuous coaching and feedback is the standard practice.

Skills

CMS regulations

Bilingual capacity

Customer service

Active listening

Team collaboration

Fast learner

Typing 40 wpm

MS Office

Education

High School Diploma or equivalent

Bachelor’s Degree or equivalent work experience

Tools

MS Office

Job description

Clever Care Health Plan is hiring a Member Advocate I to be the main point of contact for members, prospective members, providers, brokers and vendors. You will assist with benefits, eligibility, referrals, claims and other plan services while delivering superior customer service.

The role emphasizes accurate issue resolution, professionalism, and adherence to HIPAA guidelines, with a hybrid work arrangement and opportunities to contribute to community healthcare access.