Customer Services Concierge Support, Intermediate

About the role

Our Concierge Customer Experience Teams receive incoming telephone calls from BSC’s top-tier customers. Agents are trained to go above and beyond, providing high-quality, white-glove, one-stop-shop service. In this role, you will uphold our mission of providing service worthy of our family and friends. 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.

The Concierge Call Center is open 7 days a week, 4:45 a.m. – 8:00 p.m., including most holidays. If hired, you will be required to attend and complete paid, mandatory remote training. Training lasts 40 hours per week (8:00 a.m. – 4:30 p.m., Mon–Fri) for the required period. After training, agents work remotely and are assigned a daily 8-hour shift within the call center’s operating hours, totaling 40 hours per week.

Responsibilities

• Resolve incoming calls concerning member eligibility, benefits, provider information, clinical, and pharmacy needs.
• Compose routine and non-routine correspondence to answer benefits and provider inquiries in writing.
• Coordinate membership changes, such as updating a member’s primary care physician.
• Perform routine to mid-level inventory reduction (e.g., member inquiries, initiate 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 continuously improve member and customer satisfaction.
• Proactively analyze available programs, determine eligibility, and connect members to BSC vendors, Health Advocates, Social Workers, Pharmacy Techs, and Pharmacists.
• Verify member inclusion in or targeting for outreach or care gap programs and connect them to appropriate services.
• Engage members with their wellness plan options.
• Provide comprehensive resolution of pharmacy calls concerning benefits coverage, co-pays, formulary coverage, vacation overrides, and utilization management requirements.
• Explain prescription-related benefit coverage, including co-pays, formulary coverage, and utilization management requirements using web-posted or printed formulary.
• Provide brief descriptions of coverage denial reasons and alternatives listed in the printed formulary.
• Perform prescription claim overrides.
• Provide deductible and maximum out-of-pocket information.
• Assist members with the status of prior authorization requests and guide them on how to appeal a coverage decision.
• Complete mandatory upskill training as required by the business.
• Perform other duties as assigned.

Requirements

• Must reside in the state of California, preferably within a 50-mile radius of one of our office locations (El Dorado Hills, Lodi, Long Beach, Oakland, Rancho Cordova, Redding, San Diego, Woodland Hills, etc.).
• High School Diploma or GED (or equivalent).
• Typically requires at least 3 years of prior relevant experience.
• Flexibility in availability, including hours and holidays; shifts are not guaranteed.
• Must attend and complete remote training.
• Basic proficiency in Microsoft Suite systems and ability to use computer applications.
• High-speed internet connectivity (minimum 11 MBPS download and 3 MBPS upload).
• Post-training, requires a private, distraction-free work location at your residence within 15 feet of your Wi-Fi modem.
• Comfortable using a computer with dual monitors to navigate multiple screens.
• Comfortable using Excel spreadsheets to calculate member premiums for health insurance.
• Ability to multitask: talking to members while entering information into their online record.
• Patient with members calling with questions or problems.
• Strong listening skills to address both stated and unarticulated member needs.

Schedule

Full-time, 40 hours per week. Assigned shifts are 8 hours daily, including 2 scheduled breaks and a lunch period, within the call center’s operating hours (4:45 a.m. – 8:00 p.m., 7 days a week, including most holidays). Occasional holiday work is required.

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 are expected to work in-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.

Blue Shield is recognized as a U.S. News Best Company to Work For, a Deloitte U.S. Best Managed Company, and a Top 100 Inspiring Workplace. We were also recognized by Fair360 as a Top Regional Company and by Points of Light as one of the 50 most community-minded companies in the U.S.

Values

• Honest: We hold ourselves to the highest ethical and integrity standards, building trust by doing what we say and correcting shortcomings.
• Human: We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous: We stand up for what we believe in and commit to the hard work necessary to achieve our ambitious goals.