Johnson Service Group (JSG) is seeking a Member Services Navigator for a Health Plan in California. Must be Bilingual Mandarin / Cantonese- speaker.
This is a remote opportunity but must live in Northern CA. (San Mateo, San Francisco, Santa Clara, Alameda, Contra Costa or Marin).Â
Work schedule: Monday - Friday 8:30-5pm
Pay range: $26.50--$33.50 DOE
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.
• Make New Member Welcome Calls.
• 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 HPSM 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 HPSM clinical staff to facilitate care coordination and/or receipt of medical services including prescriptions.
• Participate in and professionally represent HPSM 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.
• Health Insurance programs preferred.
• 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. Â
