EmblemHealth

Bilingual Customer Care Navigator (English/Spanish) - Bronx Emblem Health

Job Category

Customer Service

• Interact 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 the 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 Emblem Health 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.

• Identify customer needs and help solve customer issues related to health plans, health and wellness and enrollment within regulatory guidelines.
• Provide direct guidance or identify other Emblem Health and community resources to find customer solutions, conduct customer needs assessment, education on condition management and care gaps.
• Understand and maintain excellent working knowledge of Emblem Health products, services and technology platforms.
• Document interactions in support of quantitative metrics for the site and department.
• 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 Advantage Care Physicians, product, customer service and quality to help improve customer experience and operations.
• Work with manager to deliver and organize onsite health seminars and classes, including EH vendor-led classes.
• Proactively communicate with customers, Emblem Health departments and community partners the status of any outstanding issues until solved.
• Deliver final resolution to customer.
• 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 Emblem Health at onsite interactions with community partners and leaders.

• Bachelor’s Degree

• 3 - 5 years of experience working with customers in customer service, medical or managed care environment. (R)
• Experience in evidence-based health and lifestyle coaching techniques preferred; willingness to attend appropriate training and certification classes. (R)
• Additional experience/specialized training may be considered in lieu of educational requirements. (R)
• Experience communicating directly with customers, assessing needs, and connecting customers with resources. (R)
• Knowledgeable on how to navigate all aspects of medical care and managed care system; health and wellness. (R)
• Ability to demonstrate excellent service knowledge and hospitality. (R)
• Must be able to demonstrate optimistic warmth and empathy for the customers’ experience. (R)
• Technologically savvy, with the ability to quickly learn and navigate different information technology systems. (R)
• Flexibility to work in different Neighborhood Care sites when needed. (R)