(Behavioral Health) Correspondence Phone Support, Intermediate

About the Role

Our Behavioral Health Customer Experience Team receives incoming telephone calls from BSC’s fully insured group customers. As a Correspondence Phone Support, Intermediate, you will report to the Operations Manager and uphold our mission of providing high-quality, white-glove service. You will help members navigate healthcare with empathy and advocacy, resolving their current issues and preventing future ones.

The Behavioral Health Call Center operates 7 days a week, 8:00 a.m. - 8:00 p.m., including most holidays. If hired, you must complete paid, mandatory remote training (8:00 a.m. - 4:30 p.m., Mon-Fri, 40 hours per week). After training, you will work remotely on an assigned 8-hour shift within the call center’s operating hours, totaling 40 hours per week.

Responsibilities

• Resolve incoming calls concerning member eligibility, claims, benefits, provider information, clinical, and pharmacy needs.
• Compose routine and non-routine correspondence to answer benefits, claims, and provider inquiries in writing.
• Perform routine to mid-level inventory reduction (e.g., member inquiries, initiate/finalize claim adjustments, respond to emails).
• Review and analyze member claims for accuracy and educate members on how benefits are applied.
• Participate in quality and efficiency workgroups to improve member/customer satisfaction.
• Proactively analyze programs, determine eligibility, and connect members to BSC vendors, Health Advocates, Social Workers, Pharmacy Techs, and Pharmacists.
• Verify member inclusion in outreach or care gap programs and connect them to appropriate services.
• Engage members with their wellness plan options.
• Resolve pharmacy calls concerning benefits coverage, co-pays, formulary coverage, vacation overrides, and utilization management requirements.
• Provide prescription-related benefit coverage (e.g., explanation of coverage, co-pays, formulary information, utilization management requirements).
• Explain coverage denial reasons and alternatives listed in the printed formulary.
• Perform prescription claim overrides and provide deductible and max out-of-pocket information.
• Assist members with the status of prior authorization requests and educate them on appealing coverage decisions.
• Other duties as assigned.

Requirements

• Must reside in California, preferably within a 50-mile radius of an office location (e.g., El Dorado Hills, Lodi, Long Beach, Oakland, Rancho Cordova, Redding, San Diego, Woodland Hills).
• High School Diploma or GED (or equivalent).
• At least 3 years of prior relevant experience; previous mental health experience is valued but not required.
• Flexibility in availability, including hours and holidays; shifts are not guaranteed.
• Must complete mandatory remote training (8:00 a.m. - 4:30 p.m., Mon-Fri, 40 hours per week).
• Basic proficiency in Microsoft Suite (Outlook, Teams) and ability to use computer applications efficiently.
• High-speed internet connectivity (minimum 11 MBPS download and 3 MBPS upload).
• Post-training, requires a private, distraction-free workspace within 15 feet of your Wi-Fi modem.
• Ability to maintain patience and care for members calling with questions or problems.
• Strong listening skills to identify and address both stated and unstated member needs.
• Comfortable using a computer with dual monitors to navigate multiple screens.
• Ability to multitask: talking to members while entering information into their online records.

Schedule

Full-time, 40 hours per week. The Behavioral Health Call Center is open 7 days a week, 8:00 a.m. - 8:00 p.m., including most holidays. After training, you will be assigned an 8-hour shift within these hours, including two scheduled breaks and a lunch period.

Pay

Pay ranges vary by location:

• California: $20.13 to $28.18 per hour.
• Bay Area: $22.69 to $31.76 per hour.

Salaries are based on candidate experience, location, and current employee salaries for similar roles.

Work Arrangement

This role allows full-time remote work post-training, but employees may be required to come into the office based on business needs. Most teams work in the office two days per week. Employees living more than 50 miles from an office or in certain member-facing roles should work with their manager to determine in-office time.

About Us

Blue Shield of California, a subsidiary of Ascendium as of January 2025, is part of the Ascendium Family of Companies, which includes Blue Shield of California Promise Health Plan, Altais (a clinical services company), and Stellarus (a company scaling healthcare solutions). Our mission is to create a healthcare system worthy of our family and friends—sustainably affordable, lower-cost, high-quality, and enhancing the member and physician experience.

We foster a supportive workplace that upholds our values: Honest (highest ethical standards), Human (effective communication and empathy), and Courageous (standing up for what we believe in). Our workplace model balances in-person collaboration with flexibility, requiring most teams to work in the office two days per week.