Customer Services Concierge Support, Intermediate

JOB DESCRIPTION
Your Role

The Shared Advantage team The Shared Advantage team is a multi-functional team providing services and support for third-party administrators (TPA), including claims processing, high dollar review, written correspondence, client services concierge phone support, and e-mail correspondence. The Customer Services Concierge Support Intermediate will report to the Operations Supervisor. In this role you will resolve incoming calls and real-time chats from the TPA’s concerning claims status and authorizations. You'll learn to process and adjust simple claims, apply return files, respond to written correspondence, and respond to email correspondence.

Your Work

In this role, you will:

• Assist members by locating providers within the Blue Shield network and finding the status of a prior authorization
• Drive and support a positive team culture
• Resolve incoming calls as needed from third-party administrators regarding claims status and prior authorizations
• Resolve incoming calls concerning members eligibility, benefits, provider information, clinical and pharmacy needs
• Process and adjust simple claims, and apply return files
• Analyze available programs, determine program eligibility, and connect member to appropriate BSC vendors, Health Advocates, Social Workers, Pharmacy Techs, and Pharmacists
• Compose routine and non-routine correspondence to answer benefits/provider inquiries in writing
• Coordinate membership changes such as member’s primary care physician
• Answer email inquiries from TPA's regarding claims status and prior authorization
• Resolve pharmacy calls concerning benefit coverage, co-pays, formulary coverage, vacation overrides, and utilization management requirements

QUALIFICATIONS
Your Knowledge and Experience

• Be dependable, reliable, responsible, and can work independently
• Requires a high school diploma or GED
• Maintain professionalism and a positive attitude
• Ability to problem-solve and resolve complex claims inquiries
• Requires at least 3 years of prior relevant experience

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:

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

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.

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 accommodation within 30 days, your offer will be rescinded.