Customer Services Concierge Support, Intermediate

JOB DESCRIPTION
Our Customer Experience Teams receive incoming telephone calls from our members. Our Call Centers are open 7 days a week . If hired, you will be required to attend and complete a paid, in person, mandatory training facilitated at our Rancho Cordova, CA location. 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 training the agent has the ability to work remotely and will be assigned a schedule based on business needs. Our regular hours of operation are M-F, 4:45am – 8pm, Saturday and Sunday, 6:45am-8pm.

Job Summary:

Mandatory Training: In Person at our Rancho Cordova, CA Office

Your Role:

As a Customer Service Representative (CSR), you are in charge of upholding our mission of providing a service worthy of our family and friends. You are empowered to provide members with peace of mind that their current issue is resolved and that none are on the horizon.

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 dont 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 an occasional weekends and 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

Your Work

• Resolve incoming calls concerning members 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 members 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 members 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 within 50 miles from Rancho Cordova, CA for this opening
• 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 a paid, in-person mandatory training facilitated in our Rancho Cordova location. After completion of training the agent has the ability to work 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
Post-training, active participation on video camera is expected

Pay Range:

The pay range for this role is: $ 18.61 to $ 26.05 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 candidates 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 were 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:

Blue Shield of California is dedicated to making work-life balance a reality. Whether you prefer to work in an office or from home, we understand flexibility is more important than ever. That’s why Blue Shield is a hybrid company, offering you the opportunity to decide where you can do your best and most meaningful work.

Two ways of working: Hybrid (our default) and office

• Hybrid – In a business unit approved office a few times per year to 3 days per week, on average

• Office – In a business unit approved office 4+ days a week, on average. If the role you’re applying for is deemed an “Essential Role,” the company has determined that the role can only be performed in a Blue Shield office or in the field and would require your to meet the office worker classification.

Physical Requirements:

Office Environment – roles involving part to full time schedule in Office Environment. Due to the current public health emergency in California, Blue Shield employees are almost all working remotely. Based in our physical offices and work from home office/deskwork – Activity level: Sedentary, frequency most of work day.

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.