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, 4:45 a.m. – 8:00 p.m., including some holidays. This position is a hybrid remote position, not office based, which may require you to travel to the office a few times a year. If hired, you will be required to attend and complete a paid, 4 - 6-week mandatory training course. You must attend each day for 8 hours, totaling 40 hours per week for the required training period. This position is defined as hybrid remote

The following job summary will help you understand the candidates/people well suited to a Call Center Team environment.

Job Summary:
Start Date: Monday 7/17/2023

As a Customer Service Representative (CSR), you are in charge of upholding our mission of providing 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:

• 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.
• Taking the lead – our CSRs take ownership of members' issues, relieving members' stress while guiding them to a quick and easy resolution.
• 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!
• Sharing insights with peers and management – our positive team culture relies on open communication to continuously improve how our work gets done.

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
• Comfortable using a computer with 2 display monitors to allow you to navigate to multiple screens for information
• To multi-task using a computer; talking to the member, and entering Member information into their online record
• 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 Excel spreadsheets to calculate Member premiums for health insurance
• Patient with Members who call into our Centers with a question or a problem

Your Work
Responsibilities include:

• 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
• Assist members may when and how to appeal a coverage decision
• Provide status of a prior authorization requests
• 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
• Provide deductible and max out of pocket information
• Coordinate membership changes such as member's primary care physician
• Resolve incoming calls concerning member's eligibility, benefits, provider information, monthly premium billing, clinical and pharmacy needs
• Other duties as assigned
• 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
• Compose routine and non-routine correspondence to answer benefits/provider inquiries in writing
• Comprehensive resolution of pharmacy calls concerning benefits coverage, co-pays, formulary coverage, vacation overrides, and utilization management requirements
• Participate in quality and efficiency workgroups to continuously improve quality member/customer satisfaction as requested

QUALIFICATIONS
Your Knowledge and Experience

• Requires basic job knowledge of Microsoft Suite systems and the ability to use applications on a computer proficiently
• Requires a high school diploma or GED
• Requires at least 3 years of prior relevant experience

If hired, you will be required to attend and complete a paid, 4 - 6-week mandatory training course. You must attend each day for 8 hours, totaling 40 hours per week for the required training period. This position is defined as hybrid remote.

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 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.
• Courageous . We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
• Human . We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.

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.