Johnson Service Group (JSG) is seeing a Bilingual Customer Service Navigator for a HealthPlan in South San Francisco CA.
Bi-Lingual in English and one of the following languages: Spanish, Tagalog, Chinese (Mandarin/Cantonese).
On-Site
Work Schedule: Monday- Friday 8:30am- 5:00pm
Pay range: $26.50- $33.50 DOE
Qualifications
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.
Skills:
• Bilingual skills in one of the following languages: Spanish, Tagalog, Chinese (Cantonese/Mandarin)
Duties & Responsibilities
Essential Functions:
• Handle inbound and outbound calls and other communications in a high-volume environment, providing excellent customer service and professionalism, in accordance with established policies and procedures, and meeting established performance and quality metrics.
• 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 Healthplan's defined scope.
• Resolve concerns accurately, promptly, professionally, and with cultural competence; ensure that explanations are appropriate to the member’s level of understanding and knowledge.
• 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 healthplan 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 all interactions 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 Healthplan 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 Healthplan 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 Healthplan professionally at health fairs, community partnerships, meetings, committees, and coalitions as assigned.
• Perform other duties as assigned.
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
