Customer Services Concierge Support, Intermediate

Blue Shield of California•El Dorado, AR

1d•Hybrid

About The Position

Our Concierge Customer Experience Teams receive incoming telephone calls from BSC’s top tier customers. Our agents are trained to go above and beyond, providing high quality, white glove, one stop shop service. The Customer Services Concierge Support, Intermediate will report to the Operations Manager. In this role you will uphold our mission of providing a service worthy of our family and friends. Our 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 training remotely. You must attend training 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 training, agents may work remotely and will be assigned a daily 8hr shift within the aforementioned hours of operation totaling 40hrs a week. The assigned shift can be different from training hours. The following job summary will help you understand the candidates/people well suited to our Designated Call Center Team. Job Summary: Projected Start date: July 6th, 2026 Mandatory Training: Remote Successful CSRs deliver an effortless customer experience by: Taking the lead – our CSRs take ownership of members' issues, relieving members' stress while guiding them to a quick and easy resolution. Identifying future problems – not only do our CSRs solve the current member concern but they actively identify and solve any lurking complications the member may encounter after their first interaction. Sharing insights with peers and management – our positive team culture relies on open communication to continuously improve how our work gets done. Having fun! – our work is important, but we don't take ourselves too seriously. We love helping others and have a fun community dedicated to doing so! You must also be: Available to work a scheduled 8-hour shift, which includes 2 scheduled breaks and a lunch period, also available to work occasional holidays as part of your regularly scheduled shift Patient with members who call into our Centers with a question or a problem A good listener and not only answer the questions they ask you, but identify and answer questions the member may not be aware they needed Comfortable using a computer with 2 display monitors to allow you to navigate to multiple screens for information Comfortable using Excel spreadsheets to calculate member premiums for health insurance To multi-task using a computer; talking to the member, and entering member information into their online record

Requirements

Must reside in the state of CA, preferrable 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.
Requires a High School Diploma or GED, or equivalent
Typically requires at least 3 years of prior relevant experience
Flexibility in availability is required including hours 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 of 11MBPS and 3 MBPS upload speed
Post-training, Requires private work location at their residence free from distractions and within 15 feet of their Wi-Fi modem

Responsibilities

Resolve incoming calls concerning member's eligibility, benefits, provider information, clinical and pharmacy needs
Compose routine and non-routine correspondence to answer benefits/provider inquiries in writing
Coordinate 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 prior authorization requests
Assist members may when and how to appeal a coverage decision
Mandatory upskill training as business requires
Other duties as assigned