Your Role

The Medicare Member Outreach team is high functioning member facing team that manages an inbound call queue, answers member inquiries, assists with various Medicare Member Engagement initiatives and completes outbound care gap closure outreach. The Correspondence Phone Support, Intermediate will report to the Supervisor, Clinical Quality Management. In this role you will ensure that every interaction with a member is approached with a focus on service. Responsible for outreach, education, and helping members access care as well as resolve customer inquiries. Educates members on the Blue Shield benefits and preventive screenings. Help members schedule an appointment with their primary provider and make calls to remind members about appointments. Answer incoming calls or written requests for information from members promptly and accurately within established production and quality standards. Coordinate with other departments to ensure timely and appropriate responses to member inquiries.

Your Work

In this role, you will:

• Educate others on the Blue Shield product, providing accurate information and updates to policies and procedures, improving overall customer satisfaction in the process
• Represent Company at employer health fairs
• Handle escalated calls; may de-escalate calls
• Expedite, research, and resolve complex customer issues.
• Answer incoming calls and written requests for information from customers promptly and accurately
• Initiate outbound calls to members and providers to collect information and provide care coordination assistance in obtaining services (schedule appointments, provider appointment reminders, coordinate transportation, etc.)
• Manage and maintain HEDIS files and medical records
• Provide administrative support, including generating correspondence, organize mass mailings, coordinator schedules and training
• Create and maintain detailed logs of member and provider interactions
• Ability to confidently de-escalate situations
• Provide project support for member outreach and HEDIS
• Ability to work independently in a fast-paced environment
• May be required to consistently perform established performance metrics, such as quality, production; average handling time (AGT) and calls per hour (CPH)
• Proactively engages the member with their plan options, benefits, and member incentive.
• Document call information within multiple systems
• Demonstrates regular, reliable, and predictable attendance

Your Knowledge and Experience

• Requires a High School Diploma or equivalent
• Requires at least 3 years of prior relevant experience in Customer Service or Healthcare.
• Requires intermediate job knowledge of systems and procedures obtained through prior work experience or education.
• Effective time management skills and ability to define and act on priorities efficiently
• Prefers communication and interpersonal skills
• Must be organized with the ability to keep accurate notes and records
• Prefers customer service experience
• Prefers critical thinking skills
• Prefers intermediate knowledge of Microsoft Suite systems and the ability to use applications as well as computer navigation at an intermediate level
• Prefers proficient knowledge of computer applications including Microsoft Word, PowerPoint, and Excel
• Strong communications and interpersonal skills are required
• HEDIS measure knowledge preferred
• Be dependable, reliable, responsible, and can work independently
• Ability to multitask, work independently with strong organizational skills

Pay Range

The pay range for this role is: $ 18.61 to $ 26.05 for California.

Note

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

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