Customer Service Navigator- Bilingual Cantonese

Johnson Service Group, Inc.; South San Francisco (CA); Hybrid; USD 55,000 - 70,000; Full time

Benefits offered by this job

Weekly pay

Medical, dental, vision insurance

401(k)

Short-term disability

Job summary

Johnson Service Group (JSG) is seeking a Member Services Navigator for a Health Plan in California. The role requires a bilingual Cantonese speaker and offers a hybrid schedule with 4 days remote and 1 day in-office on Tuesdays in the South San Francisco area.

Work hours are Monday–Friday 8:30–5:00 with pay range $26.50–$33.50 per hour DOE. The position focuses on assisting CareAdvantage members with plan benefits, navigating enrollment, and resolving issues related to benefits and services.

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.
• Knowledge of personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access, and PowerPoint.

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 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.

Skills

Customer service

Bilingual Cantonese speaker

Microsoft Office Suite

Education

High school diploma or GED

Tools

Microsoft Office Suite

Job description

Johnson Service Group (JSG) is seeking a Member Services Navigator for a Health Plan in California. Must be Bilingual Cantonese- speaker. This is Hybrid opportunity- 4days from home- 1 day in-office- Tuesdays. in the South San Franciso Area. Work schedule: Monday - Friday 8:30-5pm Pay range: $26.50--$33.50 DOE

General 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 & Responsibilities – Essential Functions

• 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 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.

Secondary Functions

Perform other duties as assigned.

Qualifications

Education and experience equivalent to:

• 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 persons with disabilities and/ in a medically related field such as medical assisting.

Knowledge of:

• 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.

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

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.

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