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Health Plan of San Mateo (HPSM) · 2 weeks ago

Customer Service Navigator I (Tagalog)

South San Francisco, CA

Full-time

Onsite

Entry Level

$25.78/hr - $32.61/hr

1+ years exp

Health Plan of San Mateo (HPSM) is seeking a Customer Service Navigator I to assist members and providers with inquiries regarding health plan benefits and services. The role involves handling high-volume calls, providing excellent customer service, and educating members about eligibility and benefits while adhering to established guidelines and regulations.

Health CareMedicalNon Profit

Comp. & Benefits

Responsibilities

Handle inbound and outbound calls and other communications in a high-volume environment, providing excellent customer service and professionalism, in accordance with established policies and procedures, and meeting established performance and quality metrics

Adhere to established guidelines, call scripts, and resources to address member and provider inquiries; this includes maintaining the confidentiality of member information and complying with HIPAA and other relevant regulations. For non-routine inquiries, leverage available resources and expertise to resolve issues that fall outside standard protocols or HPSM’s defined scope

Resolve concerns accurately, promptly, professionally, and with cultural competence; ensure that explanations are appropriate to the member’s level of understanding and knowledge

Intake, handle and coordinate member grievances, appeals and billing issues, escalating to the Grievance and Appeals department, when necessary

Educate members and providers about eligibility, benefits, and the HPSM provider network; assist members in selecting or changing their primary care physician and provide accurate information about available providers and effective dates for PCP assignments

Use listening skills and judgment to appropriately categorize and accurately document all interactions and follow-up actions regarding member and provider communications and activities in accordance with established guidelines

Refer members to appropriate community partner agencies based on their specific needs, including but not limited to Behavioral Health and Recovery Services, Aging and Adult Services, Legal Aid, Human Services Agency, and HICAP when applicable

Use strong professional judgement to determine when to escalate member or provider inquiries to other HPSM departments; share important information and collaborate with these teams to resolve issues, this includes referring members to health services for care coordination and guiding providers to specialists for help with complex claims or questions

Proactively seek opportunities to improve processes and enhance the overall member experience

Attend and actively participate in regular departmental meetings, training sessions, and coaching sessions as applicable

Cross train on a variety of tasks as requested, to ensure the continuity of HPSM operations within the Member Services department and other departments

Conduct member outreach such as welcome calls and targeted member outreach calls as assigned

Participate in and represent HPSM professionally at health fairs, community partnerships, meetings, committees, and coalitions as assigned

Perform other duties as assigned

Qualification

Customer ServiceCall Center ExperienceHealth Insurance KnowledgeMicrosoft OfficeBilingual (Tagalog)Communication SkillsTeamworkProblem Solving

Required

High school diploma or GED

One (1) or more years' experience in Customer Service or Call Center role, preferably in a health care or public-sector setting

Previous experience with managed care plans, Medi-Cal and Medicare programs, and working with underserved populations

Microsoft Office products including Word, Excel, PowerPoint and Outlook

Health insurance and medical terminology

Quality metrics relevant to a call center, and best practices for achieving them

Work cooperatively with others

Work as part of a team and support team decisions

Communicate effectively, both verbally and in writing with various audiences and individuals of diverse backgrounds

Meet deadlines and adapt to changes in requirements/priorities for daily and specialized tasks

Develop and maintain strong professional relationships with a diverse range of people

Develop and proactively maintain up-to-date knowledge of relevant quality, regulatory and organizational guidelines

Utilize a personal computer, including strong typing proficiency and the ability to use various Microsoft Office products including Word, Excel, PowerPoint and Outlook

Perform problem research, use analytical skills, and effectively influence positive outcomes

Understand written policies and procedures and apply these requirements to day-to-day work

Maintain health information confidentiality and follow information privacy and security best practices

Preferred

Bilingual skills in Spanish, Mandarin, Cantonese or Tagalog are preferred but not required

Benefits

HPSM-paid premiums for employee’s medical, dental and vision coverage (employee pays 10% of each dependent’s premiums)

Fully paid life, AD&D and LTD insurance

Retirement plan (HPSM contributes equivalent of 10% of annual compensation)

12 paid holidays a year, 12 paid sick days a year and paid vacation starting at 16 days a year

Tuition reimbursement plan

Employee wellness program

Company

Health Plan of San Mateo (HPSM)

The Health Plan of San Mateo (HPSM) is a local non-profit health care plan that offers health coverage and a provider network to San Mateo County's under-insured population.

Founded in 1987

South San Francisco, California, USA

201-500 employees