Job Overview

We are seeking a Bilingual (English/Spanish) Customer Service Representative / Concierge Navigator to join our Member Engagement team for a 6-month contract opportunity (covering a Leave of Absence, with potential to convert to FTE based on performance and business needs).

In this role, you will act as a primary point of contact and outreach specialist for health plan members. You will focus on new member onboarding, making outbound "welcome" calls to help members navigate their healthcare benefits, schedule provider appointments, close gaps in care, and ensure a seamless experience across our network. You will also provide cross-functional inbound support for member experience calls during peak seasonal volume.

Key Responsibilities

• Member Onboarding & Engagement: Conduct proactive outbound outreach (20–40 calls/day focus on quality over call handling time) including Welcome Calls, New Member Onboarding, JSA Scheduling, Product/Vendor Changes, CAHPS Proxy, and Service Recovery.

• Care Coordination: Assist members with scheduling Primary Care Physician (PCP) and specialist appointments, obtaining medical records from providers or hospitals, and assisting with authorizations or referrals.

• Compliance & Market Outreach: Execute compliance-driven outreach (such as C-SNP chronic condition verification and provider movement notifications).

• Inbound & Escalation Support: Resolve incoming member calls regarding eligibility, benefits, provider inquiries, clinical, and pharmacy needs. Cross-support the Member Experience inbound queue during peak times (such as January).

• Documentation & Follow-Up: Maintain detailed case documentation, conduct follow-ups to resolve quality issues, communicate member updates to PCPs, and mail relevant correspondence as required.

Position Details & Schedule

• Pay Rate: $24.00 / hour

• Role Type: 6-Month Contract (LOA Coverage) with FTE conversion potential

• Start Date: November 9th

• Work Location & Modality: Remote (Must reside in California)

• Shift/Schedule: Monday – Friday, 8:00 AM – 5:00 PM PST

• Equipment: Client-issued IT equipment provided

Qualifications & Requirements

Required Skills & Experience:

• High School Diploma or equivalent diploma.

• 1+ years of call center experience in a remote work environment.

• Bilingual Proficiency: Fluent in both English and Spanish (required).

• Typing Speed: Ability to type 40+ WPM (Verification score required at application).

• High-Speed Internet: Home internet speed requirement of at least 50 Mbps download / 25 Mbps upload (Verification screenshot required).

• Communication Skills: Strong verbal/written communication and interpersonal skills with a patient, empathetic, and professional demeanor.

Preferred Experience:

• Healthcare call center experience, specifically within a Health Plan or Medicare Advantage environment.

Attendance & Training Expectations

• Paid Training (4 Weeks): Mandatory 100% attendance during the first 4 weeks. Training requires webcams ON at all times, active participation, and maintaining an average score of 80% or higher on training assessments.

• Time-Off Restrictions:

  • Strict blackout period during 4-week training.

  • No time off permitted during January 2027 (Peak Season).

  • Limited holiday time off (Observed holidays include Thanksgiving, Day after Thanksgiving, and Christmas Day). Any planned time off must be requested upon application submission.

^*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

^*As a job position within our Insurance division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing medical and confidential records, verifying financial information, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients