Bilingual Customer Service Navigator – Health Plan Member Support Specialist (Remote)

About brighthush

brighthush is a forward‑thinking health plan provider dedicated to delivering personalized, high‑quality care to members across California. With a mission to empower individuals and families to achieve optimal health, brighthush blends innovative technology, compassionate service, and community partnerships to create a seamless experience for every member. Whether you’re a seasoned professional or a passionate newcomer, you’ll find a culture that values collaboration, continuous learning, and a genuine commitment to making a difference.

Key Responsibilities

As a Bilingual Customer Service Navigator, you will serve as the primary point of contact for members enrolled in brighthush’s D‑SNP and CMC plans. Your role will be pivotal in ensuring members receive timely, accurate information and support across a wide range of health and prescription benefits. Below is a detailed breakdown of what your day‑to‑day responsibilities will look like:

• Member Engagement: Handle inbound calls and inquiries from brighthush members in Spanish, Tagalog, Cantonese, or Mandarin, providing clear, empathetic, and culturally sensitive assistance.
• Benefit Education: Explain brighthush health and prescription drug benefits, eligibility criteria, and provider network options, ensuring members understand how to access care.
• Welcome Calls: Conduct proactive “New Member Welcome Calls” to introduce members to their benefits, set expectations, and gather essential information.
• Issue Resolution: Investigate and resolve member challenges related to accessing brighthush‑covered services, including medical appointments, prescription refills, and specialist referrals.
• Enrollment Retention: Monitor member enrollment status, identify at‑risk members, and collaborate with partner agencies to maintain continuous coverage.
• Documentation & Reporting: Accurately record member interactions, complaints, grievances, and appeals in the system, ensuring compliance with regulatory standards.
• Service Requests: Prepare and submit member‑initiated requests for services directly to brighthush Health Services and coordinate continuity of care with non‑contracted providers.
• Community Referrals: Connect members with appropriate community partner agencies—such as behavioral health, aging services, legal aid, or HICAP—based on individual needs.
• Clinical Coordination: Relay pertinent health information to brighthush clinical staff to facilitate care coordination and prescription management.
• Community Representation: Represent brighthush at health fairs, partnership meetings, committees, and coalitions, promoting the organization’s values and services.
• Continuous Improvement: Participate in process improvement initiatives, share best practices, and contribute to the evolution of member support strategies.

Essential Qualifications

• High school diploma or GED equivalent.
• 2–3 years of customer service experience, preferably within a health plan or related environment.
• Prior experience working with seniors, individuals with disabilities, or in a medically related role (e.g., medical assisting).
• Fluency in at least one of the following languages: Spanish, Tagalog, Cantonese, or Mandarin.
• Proficiency with personal computers and Microsoft Office Suite (Outlook, Word, Excel, Access, PowerPoint).
• Strong understanding of health insurance concepts and customer service best practices.
• Excellent communication skills—both verbal and written—in English and the chosen language.
• Ability to handle complex inquiries, resolve conflicts, and maintain composure under pressure.
• Demonstrated commitment to confidentiality, compliance, and ethical standards.

Preferred Qualifications

• Experience with electronic health record (EHR) systems or member portal platforms.
• Knowledge of behavioral health, aging services, or community resources in California.
• Previous exposure to care coordination or case management roles.
• Certification in customer service or health care administration.
• Experience working remotely with a self‑directed, results‑oriented mindset.

Skills & Competencies

• Multilingual Communication: Ability to convey complex information clearly and compassionately in multiple languages.
• Problem‑Solving: Analytical thinking to diagnose issues and develop effective solutions quickly.
• Empathy & Cultural Sensitivity: Genuine care for diverse populations and an understanding of cultural nuances.
• Time Management: Prioritize tasks, manage call volume, and meet performance metrics.
• Team Collaboration: Work effectively with clinical staff, provider services, and community partners.
• Adaptability: Thrive in a dynamic environment, embracing new technologies and processes.
• Data Integrity: Maintain accurate records and adhere to data privacy regulations.

Career Growth & Learning Opportunities

At brighthush, we believe in investing in our people. As a Bilingual Customer Service Navigator, you will have access to a range of professional development resources:

• Structured onboarding program with mentorship from senior navigators.
• Regular training sessions on health plan updates, new benefits, and regulatory changes.
• Access to online Apply for this job