CareAdvantage Navigator (Medicare Customer Support Representative)

CareAdvantage Navigator
(Medicare Customer Support Rep)

**Chinese/Mandarin or Russian speaking REQUIRED**

Full-Time w/ Benefits. Telecommute from home available only for Candidates Residing in California.

Who We Are
Founded in 1987, the Health Plan of San Mateo (HPSM) is a managed care plan that offers health coverage and a provider network to San Mateo County’s underserved Medi-Cal population. We have a culture focused on kindness, advocacy, and pride in our mission.
We believe that Healthy is for everyone—and we fight to make that possible.
Over 90% of our employees say that they take pride in the work they are doing at HPSM.

Come find out why we love what we do.

The Role
The Health Plan of San Mateo (HPSM) seeks a full time CareAdvantage Navigator to act as the primary point of contact for members of CareAdvantage CMC and assist members with all aspects of plan benefits. The essential duties and responsibilities will include the following:
• 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 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 HPSM Health Services or other departments.
• Prepare and submit member requests for continuity of care with non-contracted providers to 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 HPSM clinical staff to facilitate care coordination and/or receipt of medical services including prescriptions.
• Participate in and professionally represent HPSM at health fairs, community partnerships, meetings, committees and coalitions as requested by the Manager or Supervisor.
• Perform other duties as assigned.

The following represents the typical way to achieve the necessary skills, knowledge and ability to qualify for this position.

Education and Experience:
• 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 persons with disabilities and/or in a medically related field such as medical assisting.

Knowledge of:
• Health insurance programs preferred.
• Customer service principles and practices.
• Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access and PowerPoint.

Ability to:
• Demonstrate excellent oral and written communication skills with various audiences and individuals of diverse backgrounds.
• Perform problem research, use analytical skills, and effectively influence positive outcomes.
• Develop and maintain strong professional relationships with a diverse range of people.
• Utilize a personal computer, including the range of Microsoft Office products (Word, Excel, PowerPoint, Access, and Outlook).

Compensation and Benefits
Starting Compensation Range: Depending on Experience
Benefits Information: Excellent benefits package offered, including HPSM paid premiums for employee’s Medical, Dental and Vision coverage. Employee pays a small portion of the dependent premiums (5%) for medical and dental benefits. Additional HPSM benefits include fully paid life, AD&D, and LTD insurance; retirement plan (HPSM contributes equivalent of 10% of annual compensation); 457(b) plan; holiday and vacation pay; tuition reimbursement plan; and more.
Work Hours for This Position: 11:30am-8:00pm

How to Apply
Application Process: To apply, submit a resume and cover letter to
The Health Plan of San Mateo is proud to be an Equal Opportunity Employer and is an affirmative action employer. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status.

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