(Designated) Correspondence Phone Support, Intermediate

About the Role

Our Designated Customer Experience Teams handle incoming telephone calls from Self-Funded Large Group Commercial Plans. The call center operates Monday through Friday, 4:45 a.m. – 8:00 p.m., including some holidays.

If hired, you will complete paid, mandatory remote training for 40 hours per week (8:00 a.m. – 4:30 p.m., Monday–Friday). After successful training, you will work remotely on a 40-hour schedule between 4:45 a.m. and 8:00 p.m., Monday through Friday.

As a Designated Customer Service Representative (CSR), you will uphold our mission of providing service worthy of family and friends. You will help members navigate healthcare with empathy and advocacy, resolving current issues and preventing future ones.

• Take ownership of members' issues to relieve stress and guide them to quick resolutions.
• Identify and address potential complications members may face after their initial interaction.
• Share insights with peers and management to continuously improve processes.
• Maintain a positive, fun, and collaborative team culture.

You must be available for an 8-hour shift with scheduled breaks and lunch, including occasional holidays. You should be patient, a good listener, comfortable using a computer with dual monitors, proficient with Excel for premium calculations, and skilled at multitasking while assisting members.

Responsibilities

• Resolve incoming calls regarding member eligibility, benefits, provider information, clinical, and pharmacy needs.
• Compose routine and non-routine correspondence to address benefits and provider inquiries in writing.
• Coordinate membership changes, such as updating a member’s primary care physician.
• Handle routine to mid-level inquiries, including initiating claim adjustments and responding to emails.
• Review and analyze member claims for accuracy and educate members on benefit applications.
• Participate in quality and efficiency workgroups to improve member satisfaction.
• Proactively analyze programs, determine eligibility, and connect members to appropriate vendors, advocates, social workers, pharmacy techs, and pharmacists.
• Verify member inclusion in outreach or care gap programs and connect them to relevant services.
• Engage members with wellness plan options.
• Resolve pharmacy-related calls concerning benefits, co-pays, formulary coverage, vacation overrides, and utilization management.
• Provide prescription-related benefit coverage explanations, co-pay details, formulary information, and utilization management requirements.
• Explain coverage denial reasons and alternatives listed in the formulary.
• Perform prescription claim overrides and provide deductible and max out-of-pocket information.
• Assist members with prior authorization requests and appeals for coverage decisions.
• Perform other duties as assigned.

Requirements

• Must reside in California, preferably within a 50-mile radius of office locations such as Lodi, Rancho Cordova, Redding, Woodland Hills, Long Beach, or El Dorado Hills.
• High School Diploma or GED (or equivalent) required.
• At least 3 years of prior relevant experience.
• Flexibility in availability, including weekends and holidays; shifts are not guaranteed.
• Must complete remote training as required.
• Basic proficiency in Microsoft Suite and computer applications.
• Internet connection of at least 5Mbps (15Mbps recommended) for stable network access.
• Private, distraction-free work location within 15 feet of your Wi-Fi modem.

Preferred Qualifications

• Bilingual in Spanish, with proficiency demonstrated by an oral language proficiency test.

Work Arrangement

This role allows full-time virtual work, though employees may be required to come to the office based on business needs.

About Us

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

We foster an inclusive workplace where employees thrive and contribute to addressing community needs. 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 are committed to positive change in healthcare.

• Honest: Uphold the highest ethical and integrity standards.
• Human: Listen effectively and communicate with empathy.
• Courageous: Stand up for our beliefs and commit to achieving ambitious goals.

Our workplace model balances in-person collaboration with flexibility, typically requiring two days per week in the office for most teams. Employees living over 50 miles from an office or in certain member-facing roles may work with their manager to determine in-office time based on business needs.

Pay

Pay ranges for this role:

• 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.

Schedule

• Full-time, 40 hours per week.
• Shifts between 4:45 a.m. and 8:00 p.m., Monday through Friday, including occasional holidays.
• 8-hour shifts with scheduled breaks and a lunch period.