Medicare Benefits Navigator

Bayside Solutions; Oakland (CA); On-site; USD 25,000 - 33,000; Full time

Job summary

Bayside Solutions, Inc. is seeking a CareAdvantage Member Services Specialist in Oakland, CA to serve as the primary contact for CareAdvantage D-SNP and CMC members.

You will assist with all aspects of plan benefits and provide phone-based support for questions about health and prescription drug benefits, eligibility, and provider networks. You will make New Member Welcome Calls, resolve access issues, and document complaints and grievances.

Qualifications

• Equivalent to a high school diploma or GED.
• Two to three years' experience performing customer service, preferably in a health plan environment.
• Experience working with seniors or people with disabilities, and/or in a medically related field such as medical assisting.

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.
• 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 the Health Services.
• Prepare and submit member requests for continuity of care with non-contracted providers to the 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 the clinical staff to facilitate care coordination and/or receipt of medical services, including prescriptions.
• Participate in and professionally represent us at health fairs, community partnerships, meetings, committees, and coalitions as requested by the Manager or Supervisor.

Skills

Customer service

Healthcare plan experience

Medicare/Medi-Cal knowledge

Benefits navigation

Phone support

Documenting complaints

Education

High school diploma or GED

Tools

Microsoft Office

Job description

Bayside Solutions, Inc. is seeking a CareAdvantage Member Services Specialist in Oakland, CA to serve as the primary contact for CareAdvantage D-SNP and CMC members.

You will assist with all aspects of plan benefits and provide phone-based support for questions about health and prescription drug benefits, eligibility, and provider networks. You will make New Member Welcome Calls, resolve access issues, and document complaints and grievances.