Customer Service Representative (Cantonese or Mandarin Speaking)

Location: 9700 Flair Drive, El Monte, CA 91731

About the Role

Astrana is looking for a Customer Service Representative to join our fast-growing team. This position requires fluency in Cantonese or Mandarin to assist our member population.

Responsibilities

• Answer daily telephone calls from members, providers, health plans, insurance brokers, collection agents, and hospitals.
• Collect and elicit information from members/providers, including problems or concerns, and provide general status information.
• Verify authorization, claims, eligibility, and status.
• Document all calls carefully into the Company’s customer service module & NMM Queue system.
• Assist Supervisor and Manager with other duties as assigned, including member outreach communications via mail or telephone.
• Assist members with provider appointments and resolve walk-in member concerns.
• Provide quality service to customers in a professional and respectful manner while maintaining strict confidentiality.
• Handle specialist termination notifications sent to members.
• Process urgent Medicare Authorization Approvals and notify Medicare members.
• Arrange transportation for Medicare & Medi-Cal members.
• Participate in outreach project assignments.

Inbound Calls

• Member/Provider/Health Plan/Vendor/Hospital/Broker: Document all calls into the customer service module.
• Annual Wellness Visit (AWV) – Gift card pick-up and scheduling.
• Appointment of Representative (AOR) for Medicare Members.
• Handle Attorney/Third Party Vendor calls.
• Manage authorization status/modification/redirection/CPT code changes/quantity adds/explain denied authorizations/peer-to-peer calls/extend expired authorizations/pre-certified authorization status/retro/2nd or 3rd opinions.
• Conduct 3-way conference calls with members and health plans.
• Conference calls with providers regarding appointments, DME, and COVID-19 related questions (tests & vaccines).
• Direct Member Reimbursement (DMR).
• Eligibility – Demographic changes: address/phone/fax/name changes.
• Escalated calls from providers/members.
• Health Diary Passport and Health Source MSO inquiries.
• Assist with eligibility/change PCP/benefit inquiries with AHMC.
• HIPPA Consent – Obtain member consent verification.
• Inquiries on provider network/provider rosters and lab locations.
• Handle member & provider complaints/grievances and miscellaneous calls.
• Pharmacy – Drug/medication pick-up and coverage.
• Provide authorization status for Hospital/CM Department.
• Self-Referral Requests for Medicare.
• Track return mail and mail packages/certified mail status.
• Translations – Spanish/Chinese.
• Urgent Care – Locations/operating hours.

Outbound Calls

• Member/Provider/Health Plan/Vendor/Hospital/Broker: Assist with various outbound call tasks.
• Assist Case Management on CCS – Age-in 21 years for change of PCP from Pediatrics to FP/IM.
• Assist Marketing on email inquiries.
• Assist PR/Eligibility – Members assigned to wrong PCP/with no PCP status.
• Assist UM/Medical Directors on urgent member appointments from escalated cases.
• Authorization status response call-backs.
• Benefits – Return calls once information is obtained/verified.
• Complaints/Grievances – Return calls once resolution is obtained.
• DME – Translation support in Spanish and Chinese to confirm items/appointment set-up.
• Eligibility – Return calls to providers/labs when members are added to the system.
• Member bills – Return calls once resolution is obtained.
• Member Survey – Annual, conducted every 4th quarter.
• Outreach projects from internals – QCIT.
• Resolve walk-in member concerns.
• Specialist Termination notifications sent to members.
• Transportation arrangement for Medicare/Medi-Cal members.
• Voice mail – Return calls to callers.

Concierge Services – Essential Duties

• Assist in contacting new members/IPA member transfers on new PCP assignments as needed.
• Participate in workgroup discussions on work status/progress for new member/IPA transfers.
• Update call logs and provide daily/weekly status reports.
• Facilitate members with complex pre-existing conditions, medications, and PCP/SPC network reviews.
• Conference calls for PCP selection/change.
• Help members identify bill status and connect providers on billing and claim submission.
• Responsible for the experience of membership associated with new member/IPA transfers.
• Interact with Health Plan’s Customer Service Team to serve new member/IPA transfers.
• Problem-solve complex cases and brainstorm with MS management for resolution.
• Other duties as assigned.

Requirements

• High School Diploma or GED.
• Experience using Microsoft applications such as Word, Excel, and Outlook.
• Experience working in customer service.
• One year of related experience and/or training; or equivalent combination of education and experience.
• Fluent in Cantonese or Mandarin.

Qualifications

You're a great fit for this role if:

• You have previous work experience in a healthcare setting.

Schedule

This position is required to work Monday - Friday, 8:30 AM to 5:00 PM PST.

Pay

The target pay range for this role is $17.50 - $22.00 per hour. Actual compensation will be determined based on geographic location, experience, and other job-related factors.