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Duals Enrollment Processor (Bilingual), Intermediate

  • Job
    Full-time
    Mid Level
  • Business, Operations & Strategy
  • Long Beach, +2

AI generated summary

  • You need a high school diploma, 3 years of relevant experience, fluency in Spanish, knowledge of Medicare/Medi-Cal, customer service experience, and familiarity with FACETS, AEVS, Salesforce, MARX.
  • You will process member applications for dual eligible support programs, verify eligibility status, and assist members with Medi-Cal enrollment and inquiries on a daily basis.

Requirements

  • 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

Responsibilities

  • 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

FAQs

What programs will the Duals Enrollment Processor assist members with?

The Duals Enrollment Processor will assist members with programs such as the Medicare Savings Program (MSP), Part D Low Income Subsidy (LIS), and Medi-Cal.

Who will the Duals Enrollment Processor report to?

The Duals Enrollment Processor will report to the Duals Enrollment and Retention Manager.

What are some of the responsibilities of the Duals Enrollment Processor?

Some responsibilities include assisting dual eligible members in determining eligibility, helping them apply for programs, reviewing external systems for updates, coordinating logistics for the application process, and following up with members on their application status.

What external partners will the Duals Enrollment Processor interact with?

The Duals Enrollment Processor will interact with advocates, county Medi-Cal offices, and the federal Social Security Administration Offices to assist customers in resolving issues related to eligibility for programs.

Are there any other initiatives related to retention efforts that the Duals Enrollment Processor may engage in?

Yes, the Duals Enrollment Processor may engage in and support other initiatives related to retention efforts for members, as needed.

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Finance
Industry
5001-10,000
Employees
1939
Founded Year

Mission & Purpose

Blue Shield of California strives to create a healthcare system worthy of its family and friends that is sustainably affordable. Blue Shield of California is a tax-paying, nonprofit, independent member of the Blue Shield Association with 4.7 million members, 7,800 employees, and $22.9 billion in annual revenue. Founded in 1939 in San Francisco and now headquartered in Oakland, Blue Shield of California and its affiliates provide health, dental, vision, Medicaid and Medicare healthcare service plans in California. Blue Shield of California complies with applicable state laws and federal civil rights laws, and does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, or disability.