Your Role
*This position is located at our West Los Angeles Location & does require 5 days per week in office*
The Community Resource Center (CRC) team is responsible for managing the Blue Shield Promise Health Plan Information Resource Center (IRC) and jointly operating CRCs throughout Los Angeles County with L.A. Care. The IRC and CRCs connect members from both Blue Shield Promise and L.A. Care health plans, and the Los Angeles community, to classes and personalized services that foster community connections, address social needs, and keep people active, healthy, and informed. The Blue Shield Promise CRC Representative provides in-person support to Blue Shield Promise members and consumers who visit a CRC. That support includes, but is not limited to, health plan member services, explanation of benefits, linkage to enrollment assistance, and referral to social services and care planning. In addition, the CRC Representative assists with engaging members on select quality events and participating in CRC-sponsored activities.
Your Work
In this role, you will:
- Resolve issues and inquiries concerning members eligibility, benefits, provider information, clinical, pharmacy and other health or social service needs
- Compose routine and non-routine correspondence to answer benefits/provider inquiries in writing
- Coordinate membership changes such as member’s primary care physician. May participate in quality and efficiency workgroups to continuously improve quality member/customer satisfaction
- Analyze available programs, determine program eligibility, and connect member to appropriate BSC vendors, Health Advocates, Social Workers, Pharmacy Techs, and Pharmacists
- Conduct outreach calls and activities to inform members about the Community Resource Centers, how to access health plan benefits, and assist with scheduling appointments
- Coordinates membership changes such as member’s primary care physician
- Verify the member is included in or targeted for any outreach or care gap programs and connect members to programs or services when appropriate
- Assist with organization and hosting of unique quality events and participating in on-site, off-site Community Resource Center activities
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!
Your Knowledge and Experience
- Requires at least 3 years of professional experience
- Requires broad knowledge of operational systems and practices typically gained through extensive experience and/or education
- Requires threshold language proficiency as demonstrated by successful completion of an oral language proficiency test
- Requires extensive knowledge of the requirements by governmental payers, managed care, and other provider networks
- Customer service background highly desirable
- Must demonstrate a positive attitude, flexibility, professionalism, and dependability in all workplace activities
Pay Range:
The pay range for this role is: $ 20.27 to $ 28.38 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.