Job Title: Health Plan Customer Service Representative (Bilingual Preferred)
Job Type: Full Remote
Pay: $22/hr
Eligible Candidates: Must have prior experience with healthcare preferably in a call center.
Job Summary
As a Health Plan Customer Service Representative, you will conduct direct outreach to new Medicare Advantage Prescription Drug (MAPD) and Dual Eligible Special Needs Plan (DSNP) members, providing personalized assistance and advocacy to ensure they are well informed about their plan benefits, provider options, and how to effectively use their benefits. This is a fully remote role that emphasizes building strong relationships with members and serving as their go-to resource for any future questions or concerns.
Key Responsibilities
- Conduct direct outreach to new Medicare members, offering assistance with their MAPD and DSNP plans.
- Serve as a member advocate, ensuring members understand their plan benefits and have access to the appropriate resources and provider options.
- Act as the primary point of contact for members during the onboarding process, addressing questions and proactively identifying and resolving potential issues.
- Inform members about the resources and benefits specific to their needs and follow up to ensure they are having a positive experience with their health plan.
- Log all interactions in the required systems to maintain accurate records.
- Participate in regular training on member benefits and engagement strategies.
Must-Have Skills
- Strong background in Medicare/Medicaid (preferred).
- Ability to navigate multiple systems efficiently.
- Customer service and consumer advocacy skills.
- Experience with intake, interviews, and researching consumer or provider issues.
- Excellent written and verbal communication skills for internal and external collaboration.
- Basic understanding of managed healthcare systems and Medicare.
Day-to-Day Responsibilities
- Assist members with plan-related questions, ensuring their needs are met.
- Foster strong relationships with members to serve as their ongoing resource.
- Follow up with members to ensure they are satisfied with their health plan experience.
- Maintain up-to-date knowledge of health plan benefits and resources.
Requirements
- 2+ years of experience in customer service, consumer advocacy, or healthcare systems.
- High School diploma (required).
- Bilingual candidates preferred (Spanish/English).
Additional Information
- This position involves making retention calls to existing CHP/BND members.