Care Advantage Navigator

Pay Rate: $26.56 - $33.59 per hour

Location: Remote Role - PST

About the role

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.

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 the 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 the 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

• 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.
• Proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access, and PowerPoint.

Skills

• Customer Service
• Member Services
• Health Plan Benefits
• Medicare, Medi-Cal
• Dual Eligible Special Needs Plans (D-SNP)
• Prescription Drug Benefits
• Eligibility Verification
• Provider Networks
• Member Outreach
• Welcome Calls
• Enrollment Retention
• Benefits Navigation
• Issue Resolution
• Grievances and Appeals
• Complaint Documentation
• Service Requests
• Continuity of Care
• Care Coordination
• Community Resource Referrals
• Behavioral Health Services
• Senior Services
• Disability Services
• Health Insurance
• Medical Terminology
• Telephone Support