Customer Service Navigator

Salary Range: $47,800 - $52,000 per year

Under direct supervision, you will respond to member and provider inquiries via phone and other channels, providing comprehensive support on health plan benefits and services. You act as the primary point of contact for members, delivering prompt, accurate, and courteous assistance for general inquiries, concerns, or information requests regarding our programs, services, eligibility, or benefits.

• Handle high-volume inbound/outbound calls and other communications with professionalism.
• Follow established scripts, guidelines, and policies while protecting member confidentiality (HIPAA compliance).
• Provide culturally competent, accurate, and clear information to members and providers.
• Resolve inquiries, concerns, grievances, appeals, and billing issues.
• Escalate complex issues to the appropriate departments when necessary.
• Educate members about eligibility, benefits, provider networks, and PCP selection/changes.
• Accurately document interactions and follow-up actions.
• Refer members to community partner agencies (behavioral health, aging services, legal aid, etc.) as needed.
• Collaborate with other company departments for complex inquiries or care coordination.
• Identify opportunities to improve processes and enhance the member experience.
• Attend training, departmental meetings, and coaching sessions.
• Cross-train on other tasks to maintain operational continuity.
• Conduct outreach calls (welcome calls, targeted outreach).
• Represent our company at health fairs, community events, and meetings.
• Perform other duties as assigned.

• High school diploma or GED.
• 1+ years of customer service or call center experience (healthcare/public sector preferred).
• Experience with managed care plans, Medi-Cal, Medicare, or underserved populations is a plus.
• Microsoft Office (Word, Excel, PowerPoint, Outlook).
• Health insurance and medical terminology.
• Call center quality metrics and best practices.
• Strong verbal and written communication with diverse audiences.
• Teamwork, cooperation, and relationship-building skills.
• Adaptability to changing priorities and deadlines.
• Analytical and problem-solving skills to influence positive outcomes.
• Maintain confidentiality of health information.
• Proficiency in using computers and Microsoft Office applications.

Customer service, call center operations, high-volume inbound and outbound calls, member and provider support, healthcare customer service, health plan benefits and eligibility, managed care plans, Medi-Cal, Medicare, HIPAA compliance, confidentiality of health information, medical and health insurance terminology, culturally competent communication, bilingual communication, verbal and written communication, issue resolution, grievance and appeals handling, billing inquiries, escalation management, care coordination, member education, provider networks and PCP selection, documentation and data entry, CRM systems, outreach and welcome calls, community resource referrals, collaboration with cross-functional teams, quality metrics and performance standards, problem-solving and analytical skills, adaptability and time management, process improvement, relationship building, teamwork, public-facing representation, health fairs and community events, Microsoft Word, Microsoft Excel, Microsoft PowerPoint, Microsoft Outlook, computer proficiency

Bayside Solutions, Inc. is not able to sponsor any candidates at this time. Additionally, candidates for this position must qualify as a W2 candidate.

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