Clever Care Health Plan · 3 hours ago
Customer Service Representative Lead (Bilingual Mandarin)
Arcadia, CA
Full-time
Hybrid
Mid, Senior Level
$26.15/hr - $30.53/hr
3+ years expClever Care Health Plan is one of Southern California’s fastest-growing Medicare Advantage plans, dedicated to transforming healthcare for diverse communities. The Member Advocate Team Leader will oversee the Member Services Team, providing coaching and feedback while ensuring high-quality service to members and prospective members.
Health Care
Responsibilities
Educates members, family, providers and caregivers regarding benefits and plan options
Accurately explains benefits and plan options in person, via email, or telephonically
Provides follow-up with members by clarifying the customer’s issue, determining the cause, and identifying and explaining the solution. Escalates appropriate member issues to management or other departments as required
Provides follow-up with members by clarifying the customer’s issue, determining the cause, and identifying and explaining the solution. Escalates appropriate member issues to management or other departments as required
Participates heavily in member calling projects as assigned by management to support the overall Clever Care goal of membership retention. They will also be responsible for managing and maintaining campaign success within their language pod
Follows policies and procedures and job aids in order to maintain efficient and complaint operations; communicates suggestions for improvement and efficiencies to management; identifies and reports problems with workflows following proper departmental procedures; actively participates in departmental staff meetings and training sessions
Follows all appropriate Federal and State regulatory requirements and guidelines applicable to Clever Care Health Plan operations, as documented I company policies and procedures. Follows all HIPAA requirements
Documents transactions by completing applicable member forms and summarizing actions taken in appropriate computer system and following standards set by the department or by other authorized individuals
Ability to work in an environment where continuous coaching and feedback is the standard practice
Demonstrated critical thinking and problem-solving skills to get to the heart of the member’s issue
From start to finish, they are responsible for onboarding and training new representatives
Identify and actively drive training and development team changes, processes, staffing, and training needs
Performs inbound and outbound support for escalated callers via phone and email to de-escalate and manage challenging situations and circumstances
Closes gaps in care
Conducts telephonic enrollments for prospective members
Participates in various webinars and training offered by Medicare Learning Network, AHIP, etc. to further advance their knowledge
Represents the Member Service department at various in person events hosted by the Plan
Respond to inquiries sent through the customer service email and fax
Upon approval from management, may be able to work remotely
Qualification
Required
High school diploma or equivalent, Bachelor's Degree preferred
At least 3 years customer service experience, preferably in healthcare management and/or a call center setting. 1 of those years must be with an MAPD plan
At least 1 year experience in a supervisory or lead role, preferably in healthcare management and/or a call center setting
Bilingual in Cantonese, Mandarin, Vietnamese or Korean is required
Must pass comprehensive exam on Clever Care benefits and policies, as well as CMS guidelines
Familiarity with Centers for Medicare and Medicaid Services (CMS) regulations
Exceptional customer service skills, including verbal and written communication
Strong active listening skills
Ability to collaborate and be a team player
Must be a quick learner
Ability to remain calm and courteous when handling upset members and offering solutions to their problems and knowing when to escalate the call
Ability to listen, talk, and type at the same time
Proficiency with Microsoft Office (Word, Excel, Outlook)
Type 40 wpm
Preferred
Bachelor's Degree
At least 1 year experience in a supervisory or lead role, preferably in healthcare management and/or a call center setting
60 wpm preferred
Company
Clever Care Health Plan
Clever Care Health Plan is a healthcare company that provides health insurance for medicare services.
201-500 employees
Funding
Current Stage
Growth StageTotal Funding
unknown2021-11-01Series Unknown
Leadership Team
Karen Walker Johnson
Interim Chief Operations Officer
Khaliq Siddiq
Chief Medical Officer
Recent News
MedCity News
2025-10-30
Clever Care Health Plan
2025-08-29
Company data provided by crunchbase