Bilingual SAL Advocate

This is a fully remote position, open to applicants in California.

📋 Description

• Acts as an advocate and primary point of contact for members regarding inquiries and concerns related to benefits, eligibility, referrals, claims, and other facets of plan benefits and services.

• Ensures member satisfaction through exceptional customer service and a consistent willingness to assist while maintaining a professional demeanor.

• Delivers quality customer service by implementing the SCAN Five Service Principles.

• Informs members, families, providers, and caregivers about benefits and available plan options.

• Clearly articulates benefits and plan options both in person and through email or telephone communications.

• Conducts follow-up with members to clarify issues, identify causes, and explain solutions.

• Escalates relevant member issues to management or other departments as needed.

• Consistently achieves or surpasses departmental standards, including, but not limited to, quality, productivity, and adherence to schedule and attendance.

• Responds in a timely and appropriate manner to inquiries from members, internal staff, and providers regarding benefits, eligibility, referrals, claims, and other issues, adhering to departmental policies and procedures.

• Takes ownership of issues, concentrating on providing solutions and options for members as required until resolution.

• Enhances member satisfaction by efficiently and accurately resolving issues, complaints, and questions; coordinates solutions with providers and other departments as necessary.

• Engages in member calling projects as assigned by management to support SCAN’s overall goal of membership retention.

• Adheres to policies and procedures to maintain efficient and compliant operations; communicates suggestions for improvements to management, identifies workflow issues, and actively participates in departmental meetings and training sessions.

• Complies with all relevant Federal and State regulations and guidelines applicable to Scan Health Plan operations, as outlined in company policies and procedures.

• Adheres to all HIPAA requirements.

• Documents transactions by completing necessary member forms and summarizing actions taken in the appropriate computer system, following departmental standards or guidance from authorized individuals.

• Temporarily addresses routine member inquiries on specific medical group call queues as part of skill development.

• Contributes to team objectives by achieving related results as necessary.

⛳️ Requirements

• 1-2 years of experience in a call center or related customer service field is required.

• 1-2 years of prior experience with Medicare benefits, including Medicare Advantage Plans, is preferred.

• Experience in the healthcare, insurance, or pharmacy sectors is highly desirable.

• Ability to maintain a calm demeanor at all times, even in high-pressure situations.

• Proficient data entry and general computer skills (word processing, email) are required.

• Strong oral and written communication skills.

• A professional and pleasant telephone manner is required.

• Capacity to manage a high volume of calls while consistently delivering excellent customer service is essential.

• Proven effectiveness in a high call volume environment.

🏝️ Benefits

• An annual employee bonus program.

• Comprehensive Wellness Program.

• Generous paid time off (PTO) - 11 paid holidays per year, 1 floating holiday, birthday off, and 2 volunteer days.

• Excellent 401(k) Retirement Savings Plan with employer matching.

• Strong employee recognition program.

• Tuition reimbursement.