Your Role

The Special Programs and Retentions (SPR) team assists members, internal, and external partners (Customer Care, Sales and Enrollment, Medicare I&B, and others) with phone and email inquiries related to eligibility for programs that support dual eligibles. The Duals Enrollment Processor will report to the Duals Enrollment and Retention Manager. In this role you will mainly assist dual eligible members in determining eligibility and applying for programs under the Medicare Savings Program (MSP), Part D Low Income Subsidy (LIS), and Medi-Cal. The Dual Enrollment Processor will help the members complete an application, organize, and coordinate all logistics required for the process, including reviewing external systems for updates as well as follow up with the member for status of their application. Interact and build relationships with advocates, county Medi-Cal offices, and the federal Social Security Administration Offices to assist customers in resolving issues related to their program's eligibility. Engage and support other initiatives related to retention efforts for our members, as needed.

Your Work

In this role, you will:

• Interact daily with members who need assistance with determining eligibility for the Medicare Savings Program, Part D Low Income Subsidy, Medi-Cal, and more
• Regularly contact internal and external customers and business partners to verify or obtain additional information to complete processing work
• Process member applications for dual eligible support programs
• Assist members with Medi-Cal eligibility by working with DPSS, Access, Ombudsman, and other external partners as needed
• Review eligibility status by viewing status in Marx and Automated Eligibility Verification System (AEVS)
• Make decisions based on review of source documents for routine and difficult processing issues
• Respond to inquiries from outside departments in a timely manner
• Provide feedback to supervisor regarding system or procedural problems

Your Knowledge and Experience

• Requires a high school diploma or GED
• Requires at least 3 years of prior relevant experience
• Requires knowledge of and/or exposure to Medicare and/or Medi-Cal
• Requires being bilingual in Spanish
• Requires customer service experience
• Experience in a multi-lingual, culturally sensitive environment preferred
• Experience with FACETS, AEVS, Salesforce, MARX preferred

Pay Range:

The pay range for this role is: $ 18.61 to $ 26.05 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.