Remote Customer Service Rep (Bilingual in Spanish)

About the role

The Remote Regional Concierge Navigator provides outreach and support to all our members, ensuring they have access to the care they deserve. Supports members to navigate through their health care and benefits, connecting the dots between our provider network, health plan operations, and supplemental vendors. Maintains a high knowledge of member needs in their respective market and assists members every step of the way to ensure they are never alone in their healthcare journey and have the highest level of coordinated care.

Responsibilities

• Provides in-market, specialized member support in respective market or region.
• Conducts in-market member engagement including Welcome Calls, New Member Onboarding, JSA Scheduling, High Quality PCP and Provider Terms, Product/Vendor Changes, CAHPS Proxy, Disenrollment Quality Assurance, and Proactive Service Recovery.
• Conducts case follow-ups and quality member issue resolution for all cases assigned.
• Ensures members have access to PCP and specialists to coordinate care.
• Educates members on gaps in care and assists with scheduling provider appointments.
• Serves as the patient's liaison throughout the life cycle of the program by addressing program-specific quality measures and adhering to company guidelines/standard operating procedures.
• Makes appropriate and timely patient appointments, reminders, and confirmations and mails letters and correspondence as needed.
• Places regular/consistent outreaches to the patient.
• Communicates with PCP with any member updates and requests.
• Assists with obtaining medical records from any healthcare providers involved in care or hospitals.
• Helps members with any authorizations and referrals involved in their care plan.
• Resolves incoming calls concerning members’ eligibility, benefits, provider information, clinical, and pharmacy needs; coordinates membership changes such as member’s primary care physician and proactively engages members with their wellness plan options.
• Participates in on-site member engagement activities as needed, such as in-person member meetings, handling lobby calls at a retail or care center location, etc. (subject to change).
• Other duties as assigned.

Requirements

• Minimum 1 year of customer service experience.
• High-volume inbound customer service experience, particularly for health plan or Medicare “Member Services” roles in health plan and supplemental benefits preferred.
• Telemarketing and/or member outreach experience preferred.
• Specialized experience in escalation or resolution units preferred.

Qualifications

• High School Diploma or GED.
• Knowledge of ICD-10 and CPT codes.
• Keyboard typing 40+ words per minute.
• Ability to help members navigate access to care through Medicare Advantage or HMO, including referrals and authorizations.
• Ability to communicate positively, professionally, and effectively with others; provide leadership, teach, and collaborate with others.
• Effective written and oral communication skills; ability to establish and maintain constructive relationships with diverse members, management, employees, and vendors.
• Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.
• Ability to write routine reports and correspondence.
• Ability to speak effectively before groups of customers or employees of the organization.
• Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions.
• Ability to deal with problems involving a few concrete variables in standardized situations.
• Ability to perform mathematical calculations and calculate simple statistics correctly.
• Effective problem-solving, organizational, and time management skills, and ability to work in a fast-paced environment.
• Bilingual English/Spanish, English/Vietnamese, or English/Mandarin preferred.

Pay

Pay Range: $44,790.00 - $67,185.00. Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.