Health Plan Representative (Bilingual)

About This Role

This role acts as a primary liaison between patients, clients, and Kaiser Permanente, providing education on health plan benefits and services. It involves resolving member complaints and grievances efficiently while partnering with internal and external departments to optimize member experience.

Responsibilities

• Uphold Kaiser Permanente's Policies and Procedures, Principles of Responsibilities, and applicable laws
• Act as liaison between patient/member, external clients, and Kaiser Permanente to provide assistance and education
• Resolve member complaints and grievances and answer health-plan related questions efficiently
• Partner with other departments, such as Marketing and Health Education, for accurate information dissemination
• Research, resolve, and communicate Health Plan/coverage-related assists for members
• Educate providers, staff, and individual members on Health Plan benefits and applicable regulations
• Effectively handle and attempt to resolve member issues received from numerous sources
• Appropriately interview members regarding benefit, service, and medical care issues, in person or via phone
• Accountable for investigation of all End Of Next Business Day (ENB) issues, including data collection and documentation
• Ensure inquiry and ENB documentation and processing adhere to regulations, compliance standards, and policies