Care Advantage Navigator

Bayside Solutions; California (MO); On-site; USD 40,000 - 60,000; Full time

Job summary

Bayside Solutions, Inc. is seeking a CareAdvantage Member Services Specialist to act as the primary contact for CareAdvantage D-SNP and CareAdvantage CMC members, delivering phone-based customer service and benefit assistance.

You will answer questions about benefits and eligibility, document issues, support enrollment retention, coordinate with provider and community partners, and participate in health fairs and partnerships as requested by the Manager or Supervisor.

Qualifications

• 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/or 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.
• Health Insurance programs preferred.
• Customer service principles and practices.

Responsibilities

• Act as the primary point of contact for CareAdvantage D-SNP and CareAdvantage CMC members by phone.
• Answer questions about health and prescription drug benefits, eligibility, and provider networks.
• Make New Member Welcome Calls.
• Resolve problems accessing CareAdvantage-covered services.
• Ensure members retain enrollment by contacting members and partnering agencies.
• Clearly document member complaints, grievances and appeals.
• Follow through with proactive solutions to resolve member issues.
• Prepare and submit requests for services and continuity of care with providers.
• Refer members to community partner agencies as appropriate.

Skills

Customer service

Telephone support

Education

High school diploma or GED

Tools

Microsoft Office Suite

Outlook

Word

Excel

Access

PowerPoint

Job description

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

Duties and 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 the 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 the clinical staff to facilitate care coordination and/or receipt of medical services, including prescriptions.
• Participate in and professionally represent us at health fairs, community partnerships, meetings, committees, and coalitions as requested by the Manager or Supervisor.

Requirements and Qualifications:

• 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/or 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.
• Health Insurance programs preferred.
• Customer service principles and practices.

Desired Skills and Experience

Customer Service, Member Services, Health Plan Benefits, Medicare, Medi-Cal, Dual Eligible Special Needs Plans (D-SNP), Prescription Drug Benefits, Eligibility Verification, Provider Networks, Member Outreach, Welcome Calls, Enrollment Retention, Benefits Navigation, Issue Resolution, Grievances and Appeals, Complaint Documentation, Service Requests, Continuity of Care, Care Coordination, Community Resource Referrals, Behavioral Health Services, Senior Services, Disability Services, Health Insurance, Medical Terminology, Telephone Support, Microsoft Office Suite, Outlook, Word, Excel, Access, PowerPoint

Bayside Solutions, Inc. is not able to sponsor any candidates at this time. Additionally, candidates for this position must qualify as a W2 candidate.

Bayside Solutions, Inc. may collect your personal information during the position application process. Please reference Bayside Solutions, Inc.'s CCPA Privacy Policy at www.baysidesolutions.com.