Customer Service Specialist

Customer Service Representative Lead (Bilingual Mandarin) Arcadia Office - Arcadia, CA 91007 Overview Salary Range $26.15 - $30.53 Hourly Position Type Full Time Description Must be available to work from 11:30AM to 8:00PM. Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California's fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth. Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members' culture and values. Why Join Us? We're on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you'll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation. Job Summary Member Advocate Team Leader are amongst the main point of contact at Clever Care; interfacing with members, prospective members, providers, brokers, and vendors. A successful Member Advocate Team Leader is polite, courteous, able to solve problems quickly and effectively, and focused on providing a positive and lasting impression. Member Advocate Team Leaders are expected to oversee the Member Services Team, providing direct coaching and feedback to ensure quality. They are also expected to delegate tasks and set deadlines for the team. Member Advocate Team Leaders are expected to assess the needs of the caller and determine, based on strong operational understanding, the most appropriate and effective course of action. Member Advocate Team Leaders are also expected to develop educational training material in language and organize and facilitate training sessions for new Member Advocates in language, as well as other departments within the company as related to member service. Member Advocate Team Leaders are expected to facilitate in the development and achievement of language line based call measures within their own language pod, individually and collectively. Member Advocate Team Leaders also play an integral role in the hiring of Member Advocates as it relates to passing language requirements. Functions & Job Responsibilities Educates members, family, providers and caregivers regarding benefits and plan options. Accurately explains benefits and plan options in person, via email, or telephonically. Provides follow-up with members by clarifying the customer's issue, determining the cause, and identifying and explaining the solution. Escalates appropriate member issues to management or other departments as required. Participates heavily in member calling projects as assigned by management to support the overall Clever Care goal of membership retention. They will also be responsible for managing and maintaining campaign success within their language pod. Follows policies and procedures and job aids in order to maintain efficient and complaint operations; communicates suggestions for improvement and efficiencies to management; identifies and reports problems with workflows following proper departmental procedures; actively participates in departmental staff meetings and training sessions. Follows all appropriate Federal and State regulatory requirements and guidelines applicable to Clever Care Health Plan operations, as documented in company policies and procedures. Follows all HIPAA requirements. Documents transactions by completing applicable member forms and summarizing actions taken in appropriate computer system and following standards set by the department or by other authorized individuals. Ability to work in an environment where continuous coaching and feedback is the standard practice. Demonstrated critical thinking and problem-solving skills to get to the heart of the member's issue. From start to finish, they are responsible for onboarding and training new representatives. Identify and actively drive training and development team changes, processes, staffing, and training needs. Performs inbound and outbound support for escalated callers via phone and email to de-escalate and manage challenging situations and circumstances. Closes gaps in care. Conducts telephonic enrollments for prospective members. Participates in various webinars and training offered by Medicare Learning Network, AHIP, etc. to further advance their knowledge. Represents the Member Service department at various in person events hosted by the Plan Respond to inquiries sent through the customer service email and fax Upon approval from management, may be able to work remotely Qualifications Education and Experience High school diploma or equivalent, Bachelor's Degree preferred. At least 3 years customer service experience, preferably in healthcare management and/or a call center setting. 1 of those years must be with an MAPD plan. At least 1 year experience in a supervisory or lead role, preferably in healthcare management and/or a call center setting Bilingual in Cantonese, Mandarin, Vietnamese or Korean is required Must pass comprehensive exam on Clever Care benefits and policies, as well as CMS guidelines. Skills Familiarity with Centers for Medicare and Medicaid Services (CMS) regulations Exceptional customer service skills, including verbal and written communication Strong active listening skills Ability to collaborate and be a team player Must be a quick learner Ability to remain calm and courteous when handling upset members and offering solutions to their problems and knowing when to escalate the call Ability to listen, talk, and type at the same time. Proficiency with Microsoft Office (Word, Excel, Outlook) Type 40 wpm. 60 wpm preferred. Other: Must be able to work weekends from October- March Wage Range: $26.15 to $30.53 per hour Physical & Working Environment. Must be able to travel when needed or required Ability to operate a keyboard, mouse, phone and perform repetitive motion (keyboard); writing (note-taking) Ability to sit for long periods; stand, sit, reach, bend, lift up to fifteen (15) lbs. Ability to express or exchange ideas to impart information to the public and to convey detailed instructions to staff accurately and quickly. Work is performed in an office environment and/or remotely. The job involves frequent contact with staff and public. May occasionally be required to work irregular hours based on the needs of the business. Clever Care Health Plan is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required. Salary ranges posted on the job posting are based on California wages. Salary may be higher or lower depending on the candidate's state residency.