Customer Service Navigator-Bilingual Cantonese/Mandarin

Johnson Service Group, Inc.; San Mateo (CA); On-site; USD 37,000 - 47,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Life insurance

Short-term disability

401(k)

Weekly pay

Job summary

Johnson Service Group, Inc. is seeking a Member Services Navigator for a Health Plan in California.

This onsite position in the South San Francisco area requires bilingual Cantonese proficiency and offers a day schedule from 8:30 AM to 5:00 PM with a pay range of $26.50 to $33.50 per hour DOE. The role involves acting as the primary contact for CareAdvantage D-SNP and CareAdvantage CMC members, assisting with plan benefits, eligibility, and provider networks, and coordinating with internal teams

Qualifications

• High school diploma or GED required.
• 2–3 years of customer service experience, preferably in a health plan.
• Experience working with seniors or persons with disabilities is valued.
• Proficient in Microsoft Office (Outlook, Word, Excel, Access, PowerPoint).
• Bilingual Cantonese required.

Responsibilities

• Provide customer service to CareAdvantage members primarily on the phone.
• Answer questions about CareAdvantage benefits, eligibility, and provider network.
• Make New Member Welcome Calls.
• Resolve problems accessing CareAdvantage-covered services.
• Document member complaints, grievances, and appeals.
• Coordinate with HPSM Health Services and Provider Services.
• Refer members to community partner agencies as appropriate.
• Represent HPSM at health fairs and community meetings when requested.

Skills

Customer service

Phone support

Bilingual Cantonese

Education

High school diploma or GED

Tools

Microsoft Office

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 an Onsite opportunity in 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

• 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.
• 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.

Benefits

• 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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