Customer Service Navigator I

Join our team as a Customer Service Navigator at Health Plan of San Mateo (HPSM), where you'll be the friendly voice providing vital support to our members and providers. In this role, you'll handle member and provider inquiries via phone and other communication channels, offering helpful information about health plan benefits, eligibility, and services. You’ll ensure our members receive clear, accurate, and timely assistance while maintaining a high standard of professionalism and compliance with HIPAA and relevant regulations. Whether you’re helping members select a primary care physician or resolving billing issues, you’ll have the opportunity to make a real difference in their healthcare experience!

Key Responsibilities

• Respond to inbound and outbound calls, delivering prompt, accurate, and professional assistance regarding health plan services and benefits.
• Maintain confidentiality and comply with HIPAA regulations while addressing member and provider inquiries.
• Resolve concerns and escalate complex cases to appropriate departments when necessary, ensuring clear communication across teams.
• Educate members and providers about eligibility, benefits, and available resources, including primary care physician selection and provider networks.
• Document all interactions and follow-up actions accurately, ensuring that all information is properly categorized and accessible.
• Collaborate with community partners and refer members to relevant services, including Behavioral Health, Aging Services, Legal Aid, and more.
• Participate in member outreach, health fairs, and community events as needed to promote HPSM services.

Requirements

These are the qualifications typically needed to succeed in this position. However, you don’t need to meet every requirement to apply. 

• Education & Experience: High school diploma or GED required. At least one year of customer service or call center experience, preferably in healthcare or public-sector settings. Knowledge: Familiarity with health insurance and medical terminology, as well as call center best practices and quality metrics.
• Skills & Abilities: Strong communication skills, both verbal and written, and the ability to work effectively as part of a team. Ability to handle inquiries with cultural competence and professionalism.
• Other Requirements: Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook). Strong problem-solving skills and the ability to adapt to changing priorities.

Outstanding Benefits Package Includes:

• 100% HPSM-paid medical, dental, and vision coverage for employees (dependents' premiums are 90% covered by HPSM).
• Fully funded life insurance, AD&D, and long-term disability (LTD) coverage.
• Generous retirement plan with HPSM contributing an equivalent to 10% of your annual salary.
• Ample paid time off: 12 holidays, 12 sick days, and vacation starting at 16 days per year.
• Tuition reimbursement to support your professional growth.
• A robust employee wellness program to promote your well-being.

It is HPSM's policy to provide equal employment opportunity for all applicants and employees.  HPSM does not unlawfully discriminate based on race, religion, color, national origin, ancestry, physical disability, mental disability, medical condition, marital status, sex, age, sexual orientation, veteran status, registered domestic partner status, genetic information, gender, gender identity, gender expression, or any other characteristic protected by applicable federal, state, or local law.  HPSM also prohibits discrimination based on the perception that an applicant or employee has any of those characteristics or is associated with a person who has or is perceived to have any of those characteristics.