Community Resource Center Representative, Intermediate; Bilingual Spanish – West L

Job Category:
Customer Services and Operations

Your Role:
This position is located at our West L.A. Community Resource Center Location & require employee to work 5 days per week in the West L.A. 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.

• 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 work groups 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
• 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

• 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

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.

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.