Job DescriptionOur FEP - (Federal Employee Program) Customer Experience Teams receive incoming telephone calls from healthcare providers and active and retired Federal Employees. Call Centers are open Monday-Friday from 8:00am to 4:30pm. This position is a hybrid remote position, not office based, which may require you to travel to the office a few times a year. If hired, you will be required to attend and complete a paid, 10 week mandatory training course. You must attend each day for 8 hours, totaling 40 hours per week for the required training period. The following job summary will help you understand the candidates/people well suited to our FEP Call Center Team environment.Job Summary:Start Dates: March 2025Mandatory Training: Virtual As a FEP Customer Care Representative (CCR), you oversee and uphold our mission of providing service worthy of our family and friends. Our members look to you to help them navigate healthcare, providing empathy and advocacy. You are tasked with ensuring that our member's current and next issue are resolved. FEP is a National Plan, so BSC members under the FEP PPO program have the same benefits in all states. This requires our agents (you) to support FEP members throughout the US and work with other plans to provide a seamless experience. You will provide direct support for professional services claims, and partner with (other agencies) Anthem to resolve member issues relating to facility claims. Successful CCRs deliver an effortless customer experience by:
- Taking the lead - our CCRs take ownership of members' issues, relieving members' stress while guiding them to a quick and easy resolution.
- Identifying future problems - not only do our CCRs 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 an occasional holiday as part of your regularly scheduled shift
- Patient with members who call into our Centers with a question or a problem
- An active 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
- To multi-task using a computer; talking to the member, and entering member information into their online record
ResponsibilitiesYour Work Responsibilities include:
- Handle on a typical day an average of 30+ calls
- Resolve incoming calls concerning member's eligibility, benefits, and provider information.
- Compose routine and non-routine correspondence to answer benefits/provider inquiries in writing
- 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 and engage members with their wellness plan options
- Provide deductible and max out of pocket information
- Provide status of a prior authorization requests
- Assist members when and how to appeal a coverage decision
- Other duties as assigned
QualificationsYour Knowledge and Experience
- 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 etc.
- Requires a High School Diploma or GED, or equivalent
- 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 25 feet of their Wi-Fi modem
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.About the TeamBlue Shield of California's mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California's top companies in volunteering and giving. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us!
Our Values: - Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
- Human. We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
- Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
Our Workplace Model:Blue Shield of California is dedicated to making work-life balance a reality. Whether you prefer to work in an office or from home, we understand flexibility is more important than ever. That's why Blue Shield is a hybrid company, offering you the opportunity to decide where you can do your best and most meaningful work.Two ways of working: Hybrid (our default) and office
- Hybrid - In a business unit approved office a few times per year to 3 days per week, on average
- Office - In a business unit approved office 4+ days a week, on average. If the role you're applying for is deemed an Essential Role, the company has determined that the role can only be performed in a Blue Shield office or in the field and would require your to meet the office worker classification.
Physical Requirements: Office Environment - roles involving part to full time schedule in Office Environment. Due to the current public health emergency in California, Blue Shield employees are almost all working remotely. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.Please click here for further physical requirement detail.
Equal Employment Opportunity: External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.