Customer Service Navigator - Health Plan Support
Overview
You will own the member experience for a diverse health plan population, handling high-volume inbound inquiries across phone and digital channels. You'll navigate benefits, eligibility, and provider networks, resolving complex issues with precision and empathy. Working onsite in South San Francisco with a collaborative team, you'll be the trusted voice for members seeking clarity on their healthcare. Your expertise in Medi-Cal and Medicare programs will directly impact member satisfaction. This contract role offers a clear path to deepen your health plan knowledge and make a tangible difference daily.
What You'll Do9
- 1Handle inbound and outbound calls, resolving member and provider inquiries about benefits and eligibility using CRM tools and call scripts.
- 2Educate members on Medi-Cal and Medicare benefits, guiding them through provider selection and PCP changes with accurate effective dates.
- 3Document every interaction in the CRM system, categorizing issues and follow-up actions to ensure compliance with HIPAA and internal guidelines.
- 4Resolve grievances and billing issues, escalating complex cases to the Grievance and Appeals department when needed.
- 5Connect members with community resources like Behavioral Health and Legal Aid, ensuring culturally competent referrals.
- 6Conduct proactive outreach calls, including welcome calls and targeted campaigns, to engage members in their health journey.
- 7Collaborate with care coordination teams to support members with complex health needs, sharing critical information securely.
- 8Participate in team meetings and training sessions, cross-training on new tasks to maintain operational continuity.
- 9Represent the company at health fairs and community events, building partnerships to enhance member access.
Requirements7
- 11+ years in a Customer Service or Call Center role, preferably in healthcare or public sector.
- 2High school diploma or GED.
- 3Knowledge of Microsoft Office products including Word, Excel, and Outlook.
- 4Understanding of HIPAA privacy rules and health information confidentiality.
- 5Familiarity with Medi-Cal and Medicare programs and managed care plans preferred.
- 6Bilingual in Spanish, Mandarin, Cantonese, or Tagalog preferred.
- 7Strong verbal and written communication skills for diverse audiences.
Salary Insight
$27 - $34k per year
Location
Required Skills
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