Customer Services Concierge Support, Intermediate

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 8/7/2023
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.
• 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!
• Taking the lead – our CSRs take ownership of members' issues, relieving members' stress while guiding them to a quick and easy resolution.
• 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:

• 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
• 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 Excel spreadsheets to calculate Member premiums for health insurance
• 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

Your Work
Responsibilities include:

• Participate in quality and efficiency workgroups to continuously improve quality member/customer satisfaction as requested
• Provide status of a prior authorization requests
• Comprehensive resolution of pharmacy calls concerning benefits coverage, co-pays, formulary coverage, vacation overrides, and utilization management requirements
• Assist members may when and how to appeal a coverage decision
• 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
• Coordinate membership changes such as member's primary care physician
• 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
• Review and analyze member claims for accuracy as well as member education on how benefits are applied
• Perform routine to mid-level inventory reduction (i.e., member inquiries, may initiate claim adjustments, respond to emails, etc.)
• Resolve incoming calls concerning member's eligibility, benefits, provider information, monthly premium billing, clinical and pharmacy needs
• Other duties as assigned
• Compose routine and non-routine correspondence to answer benefits/provider inquiries in writing

Qualifications
Your Knowledge and Experience

• Requires at least 3 years of prior relevant experience
• Bilingual preferred (not required)
• Requires a high school diploma or GED
• Requires basic job knowledge of Microsoft Suite systems and the ability to use applications on a computer proficiently

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 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!