About the role
Your Role
The Information Resource Center (IRC) Representative, Advanced is responsible for managing the Blue Shield Promise Health Plan's Informational Resource Center (IRC). The IRC connects members of the community to classes and personalized services that foster community connections, address social needs, and keep people active, healthy, and informed. The Blue Shield Promise IRC Representative provides in-person support to Blue Shield Promise members and consumers who visit the IRC. 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 IRC Representative assists with engaging members on select quality events and participating in BSC-sponsored activities.
Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
*This position will require five days a week onsite at an Information Resource Center in San Diego and may require travel (locally and occasionally, Los Angeles County for training purposes)*
Your Work
In this role, you will:
Resolve issues and inquiries concerning member 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 members to appropriate vendors, Health Advocates, Social Workers, Pharmacy Techs, and Pharmacists
Conduct outreach calls and activities to inform members about the Informational Resource Center, 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 unique quality events and participating in on-site, off-site center activities
Your Knowledge and Experience
Requires a high school diploma or GED
Requires at least 5 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 12 months of experience with Medi-Cal eligibility guidelines
Requires experience in Medi-Cal application and renewal/redetermination process
Requires strong customer service background
Must demonstrate a positive attitude, flexibility, professionalism, and dependability in all workplace activities