(Medicare/MedSupp) Correspondence Phone Support, Intermediate

Senior Markets Customer Experience TeamOur Senior Markets Call Center Team receives incoming telephone calls from both our 65+, Medicare and our Duals Medicare Supplement Senior members. The Senior Markets Call Center is open 7 days a week, 7:00 a.m. 8:00 p.m., including holidays. If hired, you will be required to attend and complete paid, mandatory training remotely. You must attend each day for 8 hours, totaling 40 hours per week for the required training period. Training hours are 8:00 a.m-4:30 p.m Mon-Fri. After completion of successful training the agent may continue to work remotely in accordance with our work from home policy and will be assigned a 40-hour shift/schedule between the hours of 7am to 8pm, 5 of the 7 days a week.Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.Projected Start date: August 2026Mandatory Training: HybridAs a Senior Markets Customer Service Representative (CSR), you are in charge of upholding our mission of providing a 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 age.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 Saturday and Sunday and occasional holidays as part of your regularly scheduled shiftPatient with members who call into our Centers with a question or a problemA good listener and not only answer the questions they ask you, but identify and answer questions the member may not be aware they neededComfortable using a computer with 2 display monitors to allow you to navigate to multiple screens for informationComfortable using Excel spreadsheets to calculate member premiums for health insuranceTo multi-task using a computer; talking to the member, and entering member information into their online recordResponsibilitiesIn this role, you will:Resolve incoming calls concerning member's eligibility, benefits, provider information, monthly premium billing, clinical and pharmacy needsCompose routine and non-routine correspondence to answer benefits/provider inquiries in writingCoordinate membership changes such as member's primary care physicianPerform 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 appliedParticipate in quality and efficiency workgroups to continuously improve quality member/customer satisfaction as requestedProactively 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 optionsComprehensive resolution of pharmacy calls concerning benefits coverage, co-pays, formulary coverage, vacation overrides, and utilization management requirementsProvide 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 overridesProvide deductible and max out of pocket informationProvide status of a prior authorization requestsAssist members may when and how to appeal a coverage decisionOther duties as assignedQualificationsYour Knowledge and Experience:Must reside in the state of CA, preferably within a 50-mile radius from one of our office locations - Lodi, Rancho Cordova, Redding, Woodland Hills, Long Beach, El Dorado Hills etc.Requires a High School Diploma or GEDTypically, requires at least 3 years of prior relevant experienceFlexibility in availability is required including weekends and holidays, shifts are not guaranteedRequires attending and completing training facilitated remotelyRequires basic job knowledge of Microsoft Suite systems and the ability to use applications on a computer proficientlyRequires high internet connectivity speed of a minimum 11MBPS and 3 MBPS upload speedRequires private work location at their residence free from distractions and within 15 feet of their Wi-Fi modemPreferred Qualifications:Bilingual Spanish, Korean, Mandarin Chinese, Tagalong, Vietnamese language proficiency as demonstrated by successful completion of an oral language proficiency testHybrid Virtual WorkThis role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.About UsAbout Blue Shield of CaliforniaAs of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities 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 listen and communicate effectively, showing empathy by understanding others' perspectives.Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.Our Workplace ModelFor most teams, this means coming into the office two days per week.Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being