Customer Service Representative (Cantonese or Mandarin Speaking)

Department: Member Services

Employment Type: Full Time

Location: 9700 Flair Drive, El Monte, CA 91731

Reporting To: Liliana Felix

Compensation: $17.50 - $22.00 / hour

Description

What You'll Do

• Answer all daily telephone calls from members, providers, health plans, insurance brokers, collection agents and hospitals 
• Collect Elicit information from members/providers including the problem or concerns and provide general status information 
• Verify authorization, claims, eligibility, and status only 
• All calls carefully documented into Company’s customer service module & NMM Queue system 
• Member/Provider Service/Representative assists Supervisor and Manager with other duties as assigned 
• Member outreach communications via mail or telephone 
• Assist Member appointment with providers 
• Resolve walk-in member concerns 
• Able to provide quality service to the customers 
• Able to communicate effectively with customers in a professional and respectful manner 
• Maintain strictest confidentiality at all times 
• Specialist termination notifications sent to members 
• Urgent Medicare Authorization Approval – Notification to Medicare members 
• Transportation arrangement for Medicare & Medi-Cal members 
• Outreach Project Assignments  

• Member/Provider/Health Plan/Vendor/Hospital/Broker: 
• All calls carefully documented into Company’s customer service module 
• Annual Wellness Visit (AWV) – Gift card pick up and schedules 
• Appointment of Representative (AOR) for Medicare Members 
• Attorney / Third Party Vendor calls 
• Authorization status/Modification/Redirection/CPT Code changes/Quantity adds/Explain Denied Auth/Peer to Peer calls/Extend expired auth/Pre-certified auth status/Retro/2ndor 3rd opinion/ 
• Conduct 3 way conference call to Health Plan with member 
• Conference call with Providers – Appointments, DME, 
• COVID – 19 related questions (Tests & Vaccines) 
• Direct Member Reimbursement (DMR) 
• Eligibility – Demographic changes: Address/Phone/Fax Changes/Name change 
• Escalated calls from providers/members 
• Health Diary Passport 
• Health Source MSO – Assist & arrange inquiries on Eligibility/Change PCP/Benefit with AHMC 
• HIPPA Consent – Obtain Member Consent verification 
• Inquiries on provider network/provider rosters 
• Lab locations 
• Member & Provider Complaints/Grievances 
• Member bills  
• Miscellaneous calls 
• Pharmacy – Drug/medication pick up and coverage 
• Provide authorization status for Hospital /CM Dept 
• Self-Referral Request for Medicare 
• Return Mail 
• Track Mail Packages/ Certified mail status 
• Translations – Spanish / Chinese 
• Urgent Care / locations/ operations hours 

• Assist Case Management on CCS – age in 21 years for change of PCP from Pediatrics to FP/IM 
• Assist Marketing on email inquiries 
• Assist PR/ Elig – Members assigned to wrong PCP/with no PCP status 
• Assisted UM / Medical Directors on urgent member appointment from escalated cases 
• Authorization status response call back 
• Benefits – return call once information is obtained / verified  
• Complaints/Grievances – return calls once resolution is obtained 
• DME – Translation support in Spanish and Chinese to confirm item / appointment set up for DME department 
• Eligibility – return call to providers/labs when member is added to system while waiting at the office.  
• Member bills – return calls once resolution is obtained 
• Member Survey – Annually: every 4thquarter 
• Outreach project from internals – QCIT 
• Resolve walk in members concerns 
• Specialist Termination notification sent to members 
• Transportation arrangement for Medicare / Medi-Cal members 
• Voice mail – return calls back to callers