Johnson Service Group (JSG) is seeking a Customer Service Navigator for a Healthplan partner in South San Francisco. This is an On-site positon.
Must have bilingual skills in Spanish, Mandarin, Cantonese or Tagalog.
Work Schedule: Monday - Friday 8:00am- 4:30pm
Hourly pay range: $26.50- $33.50 DOE
General DescriptionUnder direct supervision, respond to company member and provider inquiries by telephone and other communication channels, providing members with comprehensive support regarding health plan benefits and services. Acts as the primary point of contact for members, delivering prompt, accurate, and courteous assistance via telephone and other communication channels, whether for general inquiries, concerns, or information requests about company programs, services, eligibility or benefits.
Duties & Responsibilities
- Handle inbound and outbound calls and other communications in a high-volume environment, providing excellent customer service and professionalism.
- Adhere to established guidelines, call scripts, and resources to address member and provider inquiries; this includes maintaining the confidentiality of member information and complying with HIPAA and other relevant regulations. For non-routine inquiries, leverage available resources and expertise to resolve issues that fall outside standard protocols or company defined scope.
- Intake, handle and coordinate member grievances, appeals and billing issues, escalating to the Grievance and Appeals department, when necessary.
- Educate members and providers about eligibility, benefits, and the company provider network; assist members in selecting or changing their primary care physician and provide accurate information about available providers and effective dates for PCP assignments.
- Use listening skills and judgment to appropriately categorize and accurately document allinteractions and follow-up actions regarding member and provider communications and activities in accordance with established guidelines.
- Refer members to appropriate community partner agencies based on their specific needs, including but not limited to Behavioral Health and Recovery Services, Aging and Adult Services, Legal Aid, Human Services Agency, and HICAP when applicable.
- Use strong professional judgement to determine when to escalate member or provider inquiries to other company departments; share important information and collaborate with these teams to resolve issues, this includes referring members to health services for care coordination and guiding providers to specialists for help with complex claims or questions.
- Proactively seek opportunities to improve processes and enhance the overall member experience.
- Attend and actively participate in regular departmental meetings, training sessions, and coaching sessions as applicable.
- Cross train on a variety of tasks as requested, to ensure the continuity of company operations within the Member Services department and other departments.
Secondary Functions:
- Conduct member outreach such as welcome calls and targeted member outreach calls as assigned.
- Participate in and represent company professionally at health fairs, community partnerships, meetings, committees, and coalitions as assigned.
- Perform other duties as assigned.
Education and experience equivalent to:
- High school diploma or GED.
- One (1) or more years’ experience in Customer Service or Call Center role, preferably in a health care or public-sector setting.
- Previous experience with managed care plans, Medi-Cal and Medicare programs, and working with underserved populations.
Knowledge of:
- Microsoft Office products including Word, Excel, PowerPoint and Outlook.
- Health insurance and medical terminology.
- Quality metrics relevant to a call center, and best practices for achieving them.
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. #D800
