What are the responsibilities and job description for the (Medicare/MedSupp) Correspondence Phone Support, Intermediate position at Blue Shield Of California?

Job Description

Our Senior Markets Customer Experience Teams receive incoming telephone calls from both our 65 , Medicare and Medicare Supplement Senior members. The Senior Markets Call Center is open 7 days a week, 8 : 00 a.m. - 8 : 00 p.m., including holidays. If hired, you will be required to attend and complete paid, mandatory training remotely. You must attend each day for 8 hours, totaling 40 hours per week for the required training period. Training hours are 8 : 00 a.m-4 : 30.p.m Mon-Fri. After completion of successful training the agent may continue to work remotely in accordance with our work from home policy and will be assigned a 40-hour shift / schedule between the hours of 8am to 8pm 7 days a week.

The following job summary will help you understand the candidates / people well suited to our Senior Markets Call Center Team.

Job Summary :

Projected Start date : March 24th, 2025

Mandatory Training : Remote

As a Senior Markets Customer Service Representative (CSR), you are in charge of upholding our mission of providing a service worthy of our family and friends. Our members look to you to help them navigate healthcare, providing empathy and advocacy. You are empowered to provide members with peace of mind that their current issue is resolved and that none are on the horizon. Medicare provides health coverage to individuals 65 and older or those with a severe disability regardless of age.

Successful CSRs deliver an effortless customer experience by :

Taking the lead - our CSRs take ownership of members' issues, relieving members' stress while guiding them to a quick and easy resolution.
Identifying future problems - not only do our CSRs solve the current member concern but they actively identify and solve any lurking complications the member may encounter after their first interaction.
Sharing insights with peers and management - our positive team culture relies on open communication to continuously improve how our work gets done.
Having fun! - our work is important, but we don't take ourselves too seriously. We love helping others and have a fun community dedicated to doing so!

You must also be :

Available to work a scheduled 8-hour shift, which includes 2 scheduled breaks and a lunch period, also available to work Saturday and or Sunday and occasional holidays as part of your regularly scheduled shift

Patient with members who call into our Centers with a question or a problem

A good listener and not only answer the questions they ask you, but identify and answer questions the member may not be aware they needed

Comfortable using a computer with 2 display monitors to allow you to navigate to multiple screens for information

Comfortable using Excel spreadsheets to calculate member premiums for health insurance

To multi-task using a computer; talking to the member, and entering member information into their online record

Responsibilities

Your Work

Responsibilities include :

Resolve incoming calls concerning member's eligibility, benefits, provider information, monthly premium billing, clinical and pharmacy needs

Compose routine and non-routine correspondence to answer benefits / provider inquiries in writing

Coordinate membership changes such as member's primary care physician

Perform routine to mid-level inventory reduction (i.e., member inquiries, may initiate claim adjustments, respond to emails, etc.)

Review and analyze member claims for accuracy as well as member education on how benefits are applied

Participate in quality and efficiency workgroups to continuously improve quality member / customer satisfaction as requested

Proactively analyze available programs, determine program eligibility and connect the Member to appropriate BSC vendors, Health Advocates, Social Workers, Pharmacy Techs, and Pharmacists. Verify the member is included in or targeted for any outreach or care gap programs and connect members to programs or services when appropriate. Engage members with their wellness plan options

Comprehensive resolution of pharmacy calls concerning benefits coverage, co-pays, formulary coverage, vacation overrides, and utilization management requirements

Provide prescription-related benefit coverage (e.g. explanation of coverage or benefit summary related) : Provide prescription co-pays. Provide prescription formulary coverage information and utilization management requirements using web-posted printed formulary. Provide a brief description of coverage denial reasons and alternatives listed in the printed formulary. Perform prescription claim overrides

Provide deductible and max out of pocket information

Provide status of a prior authorization requests

Assist members may when and how to appeal a coverage decision

Other duties as assigned

Qualifications

Your Knowledge and Experience

Must reside in the state of CA preferably within a 50-mile radius from one of our office locations - Lodi, Rancho Cordova, Redding, Woodland Hills, Long Beach etc.

Requires a High School Diploma or GED, or equivalent

Requires at least 3 years of prior relevant experience

Flexibility in availability is required including weekends and holidays, shifts are not guaranteed

Requires attending and completing training facilitated remotely

Requires basic job knowledge of Microsoft Suite systems and the ability to use applications on a computer proficiently

Requires high internet connectivity speed of a minimum 11MBPS and 3 MBPS upload speed

Post-training, Requires private work location at their residence free from distractions and within 25 feet of their Wi-Fi modem

Preferred Qualifications :

Bilingual - Spanish, Korean, Mandarin Chinese, Tagalong, Vietnamese language proficiency as demonstrated by successful completion of an oral language proficiency test

Camera friendly in coaching's, team meetings, 1 : 1 with leaders

Pay Range :

The pay range for this role is : $ 19.17 to $ 26.84 for California.

Note :

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

About the Team

Blue Shield of California's mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.

Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California's top companies in volunteering and giving. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us!

Our Values :

Honest . We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.

Human . We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.

Courageous . We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model :

At Blue Shield of California, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose - whether working in the office or through a hybrid approach - by providing clear expectations while respecting the diverse needs of our workforce.

Two Ways of Working :

Hybrid (Default) : Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above).Exceptions :

Member-facing and approved out-of-state roles remain remote.

Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.

For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

On-Site : Work from a business unit-approved office an average of four (4) or more days a week.

Physical Requirements :

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office / deskwork - Activity level : Sedentary, frequency most of work day.

Please click here for further physical requirement detail.

Equal Employment Opportunity :

External hires must pass a background check / drug screen. Qualified applicants with arrest records and / or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

Salary : $19 - $27

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