Customer Service - Bilingual South San Francisco, CA

Johnson Service Group, Inc.; San Francisco (CA); Hybrid; USD 36,000 - 47,000; Full time

Benefits offered by this job

Medical

Dental

Vision

Life insurance options

Short-term disability

401(k)

Weekly pay

Job summary

Johnson Service Group (JSG) is seeking a Bilingual Customer Service Navigator in South San Francisco, CA. Fluency in English and Spanish, Tagalog, or Chinese (Mandarin/Cantonese) is required. Hybrid schedule: Monday–Friday, 8:30am–5:00pm.

The role handles inbound/outbound calls, assists members with eligibility, benefits, and PCP selection, and ensures accurate documentation and HIPAA compliance. Benefits include medical, dental, vision, life insurance options, short-term disability, 401(k),

Qualifications

• High school diploma or GED.
• 1+ years in customer service or call center, healthcare or public-sector preferred.
• Experience with Medi-Cal/Medicare and underserved populations.

Responsibilities

• Handle inbound and outbound calls in a high-volume environment with excellent service and adherence to policies.
• Follow scripts and resources while protecting member confidentiality and HIPAA compliance.
• Resolve non-routine inquiries by leveraging available resources and escalating when needed.
• Educate members about eligibility, benefits, and PCP selection, providing clear information.
• Document interactions and actions accurately in the system with appropriate follow-up.
• Refer members to community partners and collaborate with other Healthplan departments as needed.

Skills

Bilingual

Education

High school diploma or GED

Tools

Microsoft Office

Job description

Johnson Service Group (JSG) is seeing a Bilingual Customer Service Navigator in South San Francisco CA. Bi-Lingual in English and one of the following languages: Spanish, Tagalog, Chinese (Mandarin/Cantonese).

Hybrid Work Schedule: Monday- Friday 8:30am- 5:00pm

Pay range: $26.50- $33.50 DOE

Qualifications

• High school diploma or GED.
• One (1) or more years’ experience in Customer Service or Call Center role, preferably in a health care or public-sector setting.
• Previous experience with managed care plans, Medi-Cal and Medicare programs, and working with underserved populations.

Knowledge of

• Microsoft Office products including Word, Excel, PowerPoint and Outlook.
• Health insurance and medical terminology.
• Quality metrics relevant to a call center, and best practices for achieving them.

Skills

• Bilingual skills in one of the following languages: Spanish, Tagalog, Chinese (Cantonese/Mandarin)

Duties & Responsibilities

Essential Functions:

• Handle inbound and outbound calls and other communications in a high-volume environment, providing excellent customer service and professionalism, in accordance with established policies and procedures, and meeting established performance and quality metrics.
• Adhere to established guidelines, call scripts, and resources to address member and provider inquiries; this includes maintaining the confidentiality of member information and complying with HIPAA and other relevant regulations.
• For non-routine inquiries, leverage available resources and expertise to resolve issues that fall outside standard protocols or Healthplan's defined scope.
• Resolve concerns accurately, promptly, professionally, and with cultural competence; ensure that explanations are appropriate to the member’s level of understanding and knowledge.
• Intake, handle and coordinate member grievances, appeals and billing issues, escalating to the Grievance and Appeals department, when necessary.
• Educate members and providers about eligibility, benefits, and the healthplan provider network; assist members in selecting or changing their primary care physician and provide accurate information about available providers and effective dates for PCP assignments.
• Use listening skills and judgment to appropriately categorize and accurately document all interactions and follow-up actions regarding member and provider communications and activities in accordance with established guidelines.
• Refer members to appropriate community partner agencies based on their specific needs, including but not limited to Behavioral Health and Recovery Services, Aging and Adult Services, Legal Aid, Human Services Agency, and HICAP when applicable.
• Use strong professional judgement to determine when to elevate member or provider inquiries to other Healthplan departments; share important information and collaborate with these teams to resolve issues, this includes referring members to health services for care coordination and guiding providers to specialists for help with complex claims or questions.
• Proactively seek opportunities to improve processes and enhance the overall member experience.
• Attend and actively participate in regular departmental meetings, training sessions, and coaching sessions as applicable.
• Cross train on a variety of tasks as requested, to ensure the continuity of Healthplan operations within the Member Services department and other departments.

Secondary Functions

• Conduct member outreach such as welcome calls and targeted member outreach calls as assigned.
• Participate in and represent Healthplan professionally at health fairs, community partnerships, meetings, committees, and coalitions as assigned.
• Perform other duties as assigned.

Benefits

• medical
• dental
• vision
• life insurance options
• short-term disability
• 401(k)
• weekly pay
• and more.

Equal Opportunity Employer

Johnson Service Group (JSG) is an Equal Opportunity Employer. JSG provides equal employment opportunities to all applicants and employees without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, marital status, protected veteran status, or any other characteristic protected by law.