Member Services Navigator

JSG (Johnson Service Group, Inc.); South San Francisco (CA); Hybrid; USD 50,000 - 75,000; Full time

Benefits offered by this job

Medical

Dental

Vision

Life Insurance

Short-term Disability

401(k)

Weekly Pay

Job summary

Johnson Service Group (JSG) is seeking a Member Services Navigator for a Health Plan in California. The role requires bilingual ability in Spanish, Tagalog, Cantonese or Mandarin and a hybrid work arrangement in South San Francisco, CA, with 2 in-office days (Tuesday and Thursday).

The navigator serves as the primary contact for members, assisting with plan benefits, eligibility, and provider networks while coordinating with Health Services and community partners to resolve issues and advocate

Qualifications

• High school diploma or GED required.
• 2–3 years of customer service experience in a health plan environment.
• Experience with seniors or persons with disabilities and medical assisting background preferred.

Responsibilities

• Provide customer service to CareAdvantage members primarily on the phone.
• Explain benefits, eligibility, and provider network.
• Resolve access issues to CareAdvantage-covered services and medications.
• Document member complaints including grievances and appeals.
• Refer members to community partner agencies as appropriate.
• Coordinate with Health Services and Provider Services to submit service requests.

Skills

Customer service

Communication

Education

High school diploma or GED

Tools

Microsoft Outlook

Microsoft Word

Microsoft Excel

Microsoft Access

Microsoft PowerPoint

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 hybrid opportunity in South San Francisco CA

2 days in office- Tuesday and Thursday

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.
• 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.
• 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.