CareAdvantage Navigator

CareAdvantage Navigator

W2 Contract

Pay Rate: $26.59 - $33.59 per hour

Location: South San Francisco, CA - Onsite Role

Duties and Responsibilities:

• 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 our Health Services.
• Prepare and submit member requests for continuity of care with non-contracted providers to the 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 our clinical staff to facilitate care coordination and/or receipt of medical services, including prescriptions.
• Participate in and professionally represent us at health fairs, community partnerships, meetings, committees, and coalitions as requested by the Manager or Supervisor.

Requirements and Qualifications:

• 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 people with disabilities and/or in a medically related field, such as medical assisting.
• Bilingual skills in Spanish, Tagalog, Mandarin, Cantonese, or Russian.
• 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.
• Work cooperatively with others.
• Work as part of a team and support team decisions.
• Communicate effectively, both verbally and in writing.
• Adapt to changes in requirements/priorities for daily and specialized tasks.
• 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).

Desired Skills and Experience

Customer service, health plan member services, health and prescription drug benefits, eligibility and provider networks, welcome calls and member outreach, enrollment retention, access to care, issue resolution, grievances and appeals, service requests, continuity of care, care coordination, community resource referrals, experience supporting seniors or people with disabilities, bilingual communication (Spanish, Tagalog, Mandarin, Cantonese, or Russian), Microsoft Office, 2-3 years of customer service experience

Bayside Solutions, Inc. is not able to sponsor any candidates at this time. Additionally, candidates for this position must qualify as a W2 candidate.

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