Bilingual Customer Care Navigator (English/Spanish) - ...

Summary of PositionWork closely with onsite sales colleagues to identify customers in need of enrollment services and provide post sales customer service teract face-to-face with customers, assisting in providing complete resolution of customer concerns including claims, benefit and enrollment inquiries through health plan navigation, health and wellness coaching and community referrals.Proactively research Emblem Health member issues utilizing multiple enterprise systems and data to explain and resolve complicated customer service issues, close care gaps, helping complete HRAs, enabling higher retention of members within the neighboring community.Help conduct seminars and workshops on premises and will play an important role in class offerings for the department. Collaborate with enterprise team members on member retention efforts and special projects within the location including: Care Management and Quality to understand member needs in the community as they relate to gaps in care; and quality efforts to provide effective in person and outreach services within the community.Provide post sales customer service follow-up with Sales colleagues, both onsite and in the field within the region, to follow up on member customer service and care needs.Work with ACPNY teams, both co-located and within the region, to aid in care gap issues, especially as they relate to social needs and customer service follow up.Represent EmblemHealth to all visitors to the sites, including internal and external partners, groups and leaders.Maintain a primary Neighborhood Care location but also support multiple Neighborhood Care sites within a region.Principal AccountabilitiesIdentify customer needs and help solve customer issues related to health plans, health and wellness and enrollment within regulatory guidelines; providing direct guidance or identifying other EmblemHealth (EH) and community resources to find customer solutions, conduct customer needs assessment, education on condition management.Understand and maintain excellent working knowledge of EmblemHealth products, services and technology platforms.Document interactions in support of quantitative metrics for the site and department.Work with the manager to deliver and organize onsite health seminars and classes, including EH vendor-led classes. Proactively communicate with customers, EmblemHealth departments and community partners the status of any outstanding issues until solved. Effectively describe final resolution to customer.Work together with sales team to identify customers in need of enrollment services and post sales customer service follow-up. Proactively support operational aspects of other internal partners such as AdvantageCare Physicians, product, customer service and quality to help improve customer experience and operations.Participate in weekly meetings with manager and team members across sites to discuss customer care issues, improvement opportunities, community offerings, and other site and company priorities.Represent EmblemHealth at onsite interactions with community partners and leaders. Qualifications:Bachelor's DegreeAdditional experiencespecialized training may be considered in lieu of educational requirements required3 - 5+ years of experience working with customers in customer service, medical or managed care environment requiredExperience in evidence-based health and lifestyle coaching techniques preferredAbility and willingness to attend appropriate training and certification classes requiredExperience communicating directly with customers, assessing needs, and connecting customers with resources requiredKnowledgeable on how to navigate all aspects of medical care and managed care system, and health and wellness requiredAbility to demonstrate excellent service knowledge and hospitality, and optimistic warmth and empathy for the customers' experience requiredExcellent communication skills (verbal, written, presentation, interpersonal) with all typeslevels of audiences requiredProficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.) requiredTechnologically savvy, with the ability to quickly learn and navigate different information technology systems requiredBilingual English Spanish requiredFlexibility to work in different Neighborhood Care sites when needed required

Created: 2025-02-18