About Clever Care Health Plan
Clever Care Health Plan is a newly founded Medicare Advantage health plan, will serve Medicare beneficiaries in Southern California. Our employees are passionate in providing the best services to our members and healthcare providers partners. Two office locations are at Arcadia, Los Angeles County and Westminster, Orange County. To learn more, please visit CleverCareHealthPlan.com.

Job Summary
Member Advocates are the main point of contact at Clever Care; interfacing with members, prospective members, providers, brokers, and vendors. Serves members by being the main point of contact at Clever Care for member questions and concerns regarding benefits, eligibility, referrals, claims, and any other aspects of plan benefits and services. A successful Member Advocate I ensures member satisfaction by providing superior customer service and displaying a willingness to help at all times while maintaining a professional demeanor.
Member Services Representatives are expected to assess the needs of the caller and determine, based on strong operational understanding, the most appropriate and effective course of action.

Functions & Job Responsibilities

• Educates members, family, providers and caregivers regarding benefits and plan options.
• Accurately explains benefits and plan options in person, via email, fax, or telephonically.
• Provides follow-up with members by clarifying the customers 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 customers issue, determining the cause, and identifying and explaining the solution. Escalates appropriate member issues to management or other departments as required.
• Participates in member calling projects as assigned by management to support the overall Clever Care goal of membership retention.
• 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.

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Qualifications

• High school diploma or equivalent, Bachelors Degree preferred.
• At least 2 years customer service experience, preferably in healthcare management and/or a call center setting
• Bilingual in Cantonese, Mandarin, Vietnamese, Korean, Spanish, Thai, Khmer, Japanese may be required.
• 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
• Familiarity with Centers for Medicare and Medicaid Services (CMS) regulations, preferred
• Proficiency with Microsoft Office (Word, Excel, Outlook)
• Type 60wpm preferred
• Must be willing and able to work weekends from October-March

Clever Care Health Plan is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

Salary ranges posted on the job posting are based on California wages. Salary may be higher or lower depending on the candidate’s state residency.