Customer Service Representative (Bilingual Spanish)

Clever Care Health Plan; Huntington Beach (CA); Hybrid; USD 30,000 - 34,000; Full time

Job summary

Clever Care Health Plan in California is seeking a Member Advocate I to be the primary contact for members, providers, and vendors, addressing questions about benefits, eligibility, referrals, claims, and services.

The role emphasizes superior customer service, HIPAA compliance, and a strong willingness to help, while maintaining a professional demeanor in a fast-moving healthcare environment.

Qualifications

• Requires a high school diploma or equivalent; bachelor's degree preferred.
• Previous customer service experience, preferably in healthcare or a call center.
• Familiarity with CMS regulations and HIPAA compliance is a plus.

Responsibilities

• Educate members about benefits and plan options.
• Explain benefits accurately in person, via email, fax, or phone.
• Provide follow-up to clarify issues and identify solutions; escalate when needed.
• Document transactions and maintain compliant records in the system.

Skills

CMS regulations

Active listening

Customer service

Bilingual capabilities

Microsoft Office

Education

High School Diploma or equivalent

Bachelor’s Degree preferred

Tools

Microsoft Office

Job description

Candidate 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 SummaryMember 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 ResponsibilitiesEducates 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 assignedQualificationsEducation and Experience:High School Diploma or equivalent required.Bachelor’s Degree or equivalent work experience preferredTwo (2) years Customer Service experience preferably in healthcare management and/or a call center settingSkills:Familiarity with Centers for Medicare and Medicaid Services (CMS) regulationsBilingual in Cantonese, Mandarin, Vietnamese, Korean, Spanish, Thai, Khmer, Japanese may be required.Exceptional customer service skills, including verbal and written communicationStrong active listening skillsAbility to collaborate and be a team playerMust be a quick learnerAbility to remain calm and courteous when handling upset members and offering solutions to their problems and knowing when to escalate the callAbility to listen, talk, and type at the same time.Proficiency with Microsoft Office (Word, Excel, Outlook)Type 40 wpm. 60 wpm preferredOther:Must be willing and able to work some weekends from October-MarchWage Range: $22.00 to $25.00 per hourPhysical & 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 requiredAbility 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 Affirmative Action workplace. 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.#LI-Hybrid