Customer Service Navigator- Bilingual - Remote South SFO

Johnson Service Group, Inc.; South San Francisco (CA); Remote; USD 36,000 - 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 bilingual Member Services Navigator for a Health Plan in California, offering a remote opportunity with a Monday–Friday schedule. Pay range is $26.50–$33.50 DOE.

The role focuses on assisting members with benefits, eligibility, and provider networks, primarily via phone, while documenting issues and coordinating with Health Services and Provider Services. Candidates should have 2–3 years of customer service experience, preferably in a health plan, and be

Qualifications

• High school diploma or GED required.
• 2–3 years of customer service experience, preferably in a health plan environment.
• Experience working with seniors or persons with disabilities and in medically related fields.

Responsibilities

• Provide customer service to CareAdvantage members primarily on the phone.
• Answer questions about health and prescription drug benefits, eligibility, and provider network.
• Make New Member Welcome Calls.
• Resolve problems accessing CareAdvantage-covered services.
• Ensure members retain enrollment by contacting members and partnering agencies.
• Document member complaints, grievances, and appeals.
• Relay health information to clinical staff for care coordination.
• Represent the company at health fairs and community partnerships.

Skills

Customer service

Bilingual

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 in either of these languages Spanish, Tagalog, Cantonese or Mandarin.

This is a remote opportunity.

Work schedule: Monday - Friday 11:30am- 8pm.

Pay range: $26.50--$33.50 DOE.

General Description

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

Secondary Functions

• Perform other duties as assigned.

Qualifications

The following represents the typical way to achieve the necessary skills, knowledge and ability to qualify for this position:

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.