California Physicians' Service - Palmdale, CA
posted 2 months ago
Full-time - Mid Level
Hybrid - Palmdale, CA
Insurance Carriers and Related Activities
About the position
The Community Resource Center Representative plays a vital role in connecting Blue Shield Promise members and the Los Angeles community to essential health services and resources. This position involves providing in-person support at the Pomona Community Resource Center, assisting members with inquiries related to eligibility, benefits, and social services, and engaging them in community activities. The representative is responsible for ensuring members are informed about available programs and services, thereby fostering community connections and promoting health and wellness.
Responsibilities
- Resolve issues and inquiries concerning members eligibility, benefits, provider information, clinical, pharmacy and other health or social service needs.
- Compose routine and non-routine correspondence to answer benefits/provider inquiries in writing.
- Coordinate membership changes such as member's primary care physician.
- Participate in quality and efficiency workgroups to continuously improve quality member/customer satisfaction.
- Analyze available programs, determine program eligibility, and connect member to appropriate BSC vendors, Health Advocates, Social Workers, Pharmacy Techs, and Pharmacists.
- Conduct outreach calls and activities to inform members about the Community Resource Centers, how to access health plan benefits, and assist with scheduling appointments.
- Verify the member is included in or targeted for any outreach or care gap programs and connect members to programs or services when appropriate.
- Assist with organization and hosting of unique quality events and participating in on-site, off-site Community Resource Center activities.
Requirements
- Requires at least 3 years of professional experience.
- Requires broad knowledge of operational systems and practices typically gained through extensive experience and/or education.
- Requires being bilingual in Spanish as demonstrated by successful completion of an oral language proficiency test.
- Requires at least 6 months of experience with Medi-Cal enrollment guidelines, specifically Medi-Cal renewal/redetermination process.
- Requires customer service background.
- Must demonstrate a positive attitude, flexibility, professionalism, and dependability in all workplace activities.
Benefits
- Health insurance
- Work from home
