JOB DESCRIPTION
Our Medi-Cal Customer Experience Teams receive incoming telephone calls from our members who require assistance to help them navigate their Blue Shield of California Medi-Cal Insurance Coverage. This position is a hybrid remote position, not office based, which may require you to travel to the office a few times a year. The Medi-Cal Call Centers are open Monday - Friday, 8:00 a.m. – 6:00 p.m., including holidays. If hired, you will be required to attend and complete a paid, 6–10-week mandatory training course. You must attend each day for 8 hours 8:00am-4:30pm, totaling 40 hours per week for the required training period.
The following job summary will help you understand the candidates/people well suited to our Medi-Cal Call Center Team.
Job Summary:
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Start Date: 8/7/2023
Our Medi-Cal Customer Experience Teams receive incoming telephone calls from our members who require assistance to help them navigate their Blue Shield of California Medi-Cal Insurance Coverage. This position is a hybrid remote position, not office based, which may require you to travel to the office a few times a year. The Medi-Cal Call Centers are open Monday - Friday, 8:00 a.m. – 6:00 p.m., including holidays. If hired, you will be required to attend and complete a paid, 6–10-week mandatory training course. You must attend each day for 8 hours 8:00am-4:30pm, totaling 40 hours per week for the required training period.
As a Medi-Cal Correspondence Phone Support, Intermediate (Bilingual), you are in charge of upholding our mission of providing 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 income, whereas Medi-Cal (California's state-run and funded Medicaid program) provides health coverage to those families with low income, as well as others who might be eligible for this program.
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 an occasional holiday 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
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
- Bilingual Spanish Preferred
- Requires a high school diploma or GED, or equivalent
- Requires at least 3 years of prior relevant experience
- Spanish language proficiency as demonstrated by successful completion of an oral language proficiency test
- Requires basic job knowledge of Microsoft Suite systems and the ability to use applications on a computer proficiently
Pay Range:
The pay range for this role is: $ 18.07 to $ 25.30 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 US
At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. We're excited to share Blue Shield of California has received awards and recognition for LGBT diversity, quality improvement, most influential women in corporate America, Bay Area's top companies in volunteering & giving, and one of the world's most ethical companies. Here at Blue Shield of California, we're striving to make a positive change across our industry and the communities we live in , Join us!
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 truly 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 comprehensive approach to diversity, equity, and inclusion combines a focus on our people, processes, and systems with a deep commitment to promoting social justice and health equity through our products, business practices, and presence as a corporate citizen.
Blue Shield has received awards and recognition for being a certified Great Place to Work, best place to work for LGBTQ equality, leading disability employer, one of the best companies for women to advance, Bay Area’s top companies in volunteering & giving, and one of the world’s most ethical companies. Here at Blue Shield of California, we are striving to make a positive change across our industry and the communities we live in – 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.
COVID-19 Vaccination Policy:
From the earliest days of the pandemic, Blue Shield of California has been unyielding in our commitment to putting the health and safety of our people, our members and our communities first. As a health care company, Blue Shield requires all employees to be up to date with COVID-19 vaccination prior to start date as a condition of employment. Blue Shield will consider requests for medical or religious accommodation to this vaccination requirement prior to your start date.
The definition of "up to date with your COVID-19 vaccine" is when you have received all doses in the primary series and one booster when eligible. If you are unable to be up to date with your COVID-19 vaccine by your start date, your start date will need to be postponed and you will have 30 days to remedy. If you cannot fulfill the requirement nor obtain an accommodation within 30 days, your offer will be rescinded.
