Medicare Customer Support Rep - CareAdvantage - Russian / Chinese / Spanish Speaking

San Mateo County, California
Salary DOE + Comprehensive Benefits Package
Jul 25, 2019
Sep 23, 2019
Job Type
Full Time

Position Overview:

The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time CareAdvantage Navigator to 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.

The essential duties and responsibilities will include the following: 

  • 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 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.
  • Perform other duties as assigned.


Education and Experience:

  • 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:

  • Health insurance programs preferred.
  • Customer service principles and practices.
  • Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access and PowerPoint.

Ability to:

  • Demonstrate excellent oral and written communication skills with various audiences and individuals of diverse backgrounds.
  • Perform problem research, use analytical skills, and effectively influence positive outcomes.
  • Develop and maintain strong professional relationships with a diverse range of people.
  • Utilize a personal computer, including the range of Microsoft Office products (Word, Excel, PowerPoint, Access, and Outlook).

Compensation & Benefits

Starting Compensation Range: Depends on experience.

Other: ***Fluency in Russian, Chinese, or  Spanish is required for this position.***

Work Hours for this position: 11:30am – 8:00pm, 8:30am – 5:30, or 9:00am – 6:00pm

Benefits Information:

Excellent benefits package offered, including HPSM paid premiums for employee’s Medical, Dental and Vision coverage.  Employee pays a small portion of the dependent premiums (5%) for medical and dental benefits.  Additional HPSM benefits include fully paid life, AD&D, and LTD insurance; retirement plan (HPSM contributes equivalent of 10% of annual compensation); holiday and vacation pay; tuition reimbursement plan; onsite fitness center and more.

Apply for Medicare Customer Support Rep - CareAdvantage - Russian / Chinese / Spanish Speaking

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