Blue Shield of California

As a FEP Customer Care Representative (CCR), you oversee and uphold our mission of providing service worthy of our family and friends.. FEP is a National Plan, so BSC members under the FEP PPO program have the same benefits in all states.. You will provide direct support for professional services claims, and partner with (other agencies) Anthem to resolve member issues relating to facility claims.. 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. Provide status of a prior authorization requests

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Our FEP – (Federal Employee Program) Customer Experience Teams receive incoming telephone calls from healthcare providers and active and retired Federal Employees. Call Centers are open Monday-Friday from 8:00am to 4:30pm.  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, 10 week mandatory training course. You must attend each day for 8 hours, 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 FEP Call Center Team environment.
Job Summary:
Start Date: June 3, 2024   
Mandatory Training and Business Hours: Monday- Friday 8:00am-4:30pm 
As a FEP Customer Care Representative (CCR), you oversee and uphold 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 tasked with ensuring that our member’s current and next issue are resolved. FEP is a National Plan, so BSC members under the FEP PPO program have the same benefits in all states. This requires our agents (you) to support FEP members throughout the US and work with other plans to provide a seamless experience. You will provide direct support for professional services claims, and partner with (other agencies) Anthem to resolve member issues relating to facility claims. 
 
Successful CCRs deliver an effortless customer experience by: 
<ul>
 <li>Taking the lead – our CCRs take ownership of members' issues, relieving members' stress while guiding them to a quick and easy resolution. </li>
 <li>Identifying future problems – not only do our CCRs solve the current member concern but they actively identify and solve any lurking complications the member may encounter after their first interaction. </li>
 <li>Sharing insights with peers and management – our positive team culture relies on open communication to continuously improve how our work gets done. </li>
 <li>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! </li>
</ul>
 
You must also be:
<ul>
 <li>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</li>
 <li>Patient with members who call into our Centers with a question or a problem</li>
 <li>An active listener and not only answer the questions they ask you, but identify and answer questions the member may not be aware they needed</li>
 <li>Comfortable using a computer with 2 display monitors to allow you to navigate to multiple screens for information</li>
 <li>To multi-task using a computer; talking to the member, and entering member information into their online record</li>
</ul>
 
Your Work  Responsibilities include: 
<ul>
 <li>Handle on a typical day an average of 30+ calls </li>
 <li>Resolve incoming calls concerning member's eligibility, benefits, and provider information. </li>
 <li>Compose routine and non-routine correspondence to answer benefits/provider inquiries in writing </li>
 <li>Perform routine to mid-level inventory reduction (i.e., member inquiries, may initiate claim adjustments, respond to emails, etc.)  </li>
 <li>Review and analyze member claims for accuracy as well as member education on how benefits are applied</li>
 <li>Participate in quality and efficiency workgroups to continuously improve quality member/customer satisfaction as requested </li>
 <li>Proactively analyze available programs and engage members with their wellness plan options </li>
 <li>Provide deductible and max out of pocket information </li>
 <li>Provide status of a prior authorization requests </li>
 <li>Assist members when and how to appeal a coverage decision </li>
 <li>Other duties as assigned </li>
</ul>
 Your Knowledge and Experience <ul><li>Requires a High School Diploma or GED, or equivalent </li><li>Requires at least 3 years of prior relevant experience </li><li>Requires basic job knowledge of Microsoft Suite systems and the ability to use applications on a computer proficiently </li><li>Requires high internet connectivity speed of a minimum 11MBPS and 3 MBPS upload speed</li><li>Requires private work location at their residence free from distractions and within 20-25 feet of their Wi-Fi modem</li><li>Requires active participation on video camera is expected.</li></ul> 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.

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