Customer Service Representative (Bilingual Spanish)

Paycom; Arcadia (CA); Hybrid; USD 30,000 - 34,000; Full time

Job summary

Clever Care Health Plan in Arcadia, CA is hiring a Member Advocate I to be the primary contact for members and providers, handling benefits questions, eligibility, referrals, and claims while delivering excellent service.

The role is hybrid with three days onsite at Monrovia or Huntington Beach offices; requires High School Diploma, 2 years in customer service; bilingual preferred; wage $22-$25 per hour; includes HIPAA compliance.

Qualifications

• High School Diploma or equivalent required.
• Bachelor’s Degree or equivalent work experience preferred.
• Two years of customer service experience, healthcare setting preferred.

Responsibilities

• Educates members and providers about benefits and plan options.
• Explains benefits and options in person, email, or call.
• Follows up to clarify issues and determine solutions; escalates when needed.
• Support member retention through proactive outreach and projects.
• Follow policies, procedures and HIPAA requirements in daily tasks.
• Document transactions accurately in the system and maintain records.

Skills

CMS regulations

Bilingual (preferred)

Customer service

Active listening

Team player

Typing 40 wpm

Microsoft Office

Education

High School Diploma

Bachelor’s Degree (preferred)

Tools

Microsoft Office

Job description

Job DetailsJob Location: Arcadia Office - Arcadia, CA 91007Position Type: Full TimeSalary Range: $22.00 - $25.00 HourlyCandidate must be available to work an eight hour shift between 8 am to 6 pm.

This position operates on a hybrid work schedule. This position will require 3 days onsite at the Monrovia or Huntington Beach office.

Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California’s fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth.

Who Are We?

Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members’ culture and values.

Why Join Us?

We’re on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you’ll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation.

Job Summary

Member Advocates are the main point of contact at Clever Care; interfacing with members, prospective members, providers, brokers, and vendors. Serves members by being the main point of contact at Clever Care for member questions and concerns regarding benefits, eligibility, referrals, claims, and any other aspects of plan benefits and services. A successful Member Advocate I ensures member satisfaction by providing superior customer service and displaying a willingness to help at all times while maintaining a professional demeanor.

Member Services Representatives are expected to assess the needs of the caller and determine, based on strong operational understanding, the most appropriate and effective course of action.

Functions & Job Responsibilities

• Educates members, family, providers and caregivers regarding benefits and plan options.
• Accurately explains benefits and plan options in person, via email, fax, or telephonically.
• Provides follow-up with members by clarifying the customer’s issue, determining the cause, and identifying and explaining the solution. Escalates appropriate member issues to management or other departments as required.
• Provides follow-up with members by clarifying the customer’s issue, determining the cause, and identifying and explaining the solution. Escalates appropriate member issues to management or other departments as required.
• Participates in member calling projects as assigned by management to support the overall Clever Care goal of membership retention.
• Follows policies and procedures and job aids in order to maintain efficient and complaint operations; communicates suggestions for improvement and efficiencies to management; identifies and reports problems with workflows following proper departmental procedures; actively participates in departmental staff meetings and training sessions.
• Follows all appropriate Federal and State regulatory requirements and guidelines applicable to Clever Care Health Plan operations, as documented I company policies and procedures. Follows all HIPAA requirements.
• Documents transactions by completing applicable member forms and summarizing actions taken in appropriate computer system and following standards set by the department or by other authorized individuals.
• Ability to work in an environment where continuous coaching and feedback is the standard practice.
• Other duties as assigned

Qualifications

Education and Experience:

• High School Diploma or equivalent required.
• Bachelor’s Degree or equivalent work experience preferred
• Two (2) years Customer Service experience preferably in healthcare management and/or a call center setting

Skills:

• Familiarity with Centers for Medicare and Medicaid Services (CMS) regulations
• Bilingual in Cantonese, Mandarin, Vietnamese, Korean, Spanish, Thai, Khmer, Japanese may be required.
• Exceptional customer service skills, including verbal and written communication
• Strong active listening skills
• Ability to collaborate and be a team player
• Must be a quick learner
• Ability to remain calm and courteous when handling upset members and offering solutions to their problems and knowing when to expand the call
• Ability to listen, talk, and type at the same time.
• Proficiency with Microsoft Office (Word, Excel, Outlook)
• Type 40 wpm. 60 wpm preferred

Other:

• Must be willing and able to work some weekends from October-March

Wage Range:

Wage Range: $22.00 to $25.00 per hour

Physical & Working Environment.

Physical requirements needed to perform the essential functions of the job, with or without reasonable accommodation:

• Must be able to travel when needed or required
• Ability to operate a keyboard, mouse, phone and perform repetitive motion (keyboard); writing (note-taking)
• Ability to sit for long periods; stand, sit, reach, bend, lift up to fifteen (15) lbs.

Ability to express or exchange ideas to impart information to the public and to convey detailed instructions to staff accurately and quickly.

Work is performed in an office environment and/or remotely. The job involves frequent contact with staff and public. May occasionally be required to work irregular hours based on the needs of the business.

Clever Care Health Plan is proud to be an Equal Employment Opportunity and Aff… Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

Salary ranges posted on the job posting are based on California wages. Salary may be higher or lower depending on the candidate’s state residency.

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