(Medicare/MedSupp) Correspondence Phone Support, Intermediate

About the role

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.

Responsibilities

• Resolve incoming calls concerning member's eligibility, benefits, provider information, monthly premium billing, clinical and pharmacy needs
• Compose routine and non-routine correspondence to answer benefits/provider inquiries in writing
• Care for membership changes such as member's primary care physician
• Perform 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 applied
• Participate in quality and efficiency workgroups to continuously improve quality member/customer satisfaction as requested
• Proactively 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 options
• Comprehensive resolution of 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 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 overrides
• Provide deductible and max out of pocket information
• Provide status of a prior authorization requests
• Aid members may when and how to appeal a coverage decision

Qualifications

• 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 GED
• Typically, requires at least 3 years of prior relevant experience
• Flexibility in availability is required including weekends and holidays, shifts are not guaranteed
• Requires attending and completing training facilitated remotely
• Requires basic job knowledge of Microsoft Suite systems and the ability to use applications on a computer proficiently
• Requires high internet connectivity speed of a minimum 11MBPS and 3 MBPS upload speed
• Requires private work location at their residence free from distractions and within 15 feet of their Wi-Fi modem