Job Description

Your Role

*This position is located at our Wilmington Community Resource Center Location & require employee to work 5 days per week in the Wilmington Community Resource Center* 

The Community Resource Center (CRC) team is responsible for managing the Blue Shield Promise Health Plan Information Resource Center (IRC) and jointly operating CRCs throughout Los Angeles County with L.A. Care. The IRC and CRCs connect members from both Blue Shield Promise and L.A. Care health plans, and the Los Angeles community, to classes and personalized services that foster community connections, address social needs, and keep people active, healthy, and informed. The Blue Shield Promise CRC Representative provides in-person support to Blue Shield Promise members and consumers who visit a CRC. That support includes, but is not limited to, health plan member services, explanation of benefits, linkage to enrollment assistance, and referral to social services and care planning. In addition, the CRC Representative assists with engaging members on select quality events and participating in CRC-sponsored activities.

Your Work

In this role, you will:

• 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. May 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
• Coordinates membership changes such as member’s primary care physician
• 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

Your Knowledge and Experience

• 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

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