Promise Healthcare Jobs (NOW HIRING)

Your Role 

*This position is located at our Metro L.A. Community Resource Center Location & require employee to work 5 days per week in the Metro L.A. Community Resource Center - 1233 S Western Ave, Los Angeles, CA 90006*

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.

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.
 

About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies. 

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. 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 achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. 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 listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals. 

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. 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.

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

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 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 unique quality events and participating in on-site, off-site Community Resource Center activities