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

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.

Requirements

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.