Enrollment and Retention Specialist - Medi-Cal (Non-Sales), Intermediate (Bilingual)

Blue Shield of California; California; Hybrid; USD 30,000 - 41,000; Full time

Job summary

Blue Shield of California Promise Health Plan is seeking an Enrollment and Retention Specialist to educate callers on Medi-Cal enrollment and eligibility, supporting retention goals. The role includes assisting with annual redetermination and advocacy with agencies, while ensuring compliance and documentation.

The successful candidate will contribute to growth programs, interact with callers via phone, and support testing new processes and system enhancements as needed.

Qualifications

• High school diploma or GED, or equivalent experience.
• At least 3 years of relevant experience.
• Strong knowledge of Medi-Cal program and managed care products/services.
• Bilingual in Spanish.
• Maintaining active compliance certifications.

Responsibilities

• Handle day-to-day growth and retention calls meeting department standards.
• Provide eligibility and enrollment information to identify best Blue Shield product.
• Facilitate member enrollment with Federal, State and Local County agencies, escalating complex cases as needed.
• Assist existing members to stay in any Blue Shield product.
• Follow up thoroughly and manage tracking systems for cases.

Skills

Bilingual in Spanish

Medi-Cal knowledge

Active compliance certifications

Education

High School Diploma or GED or equivalent experience

Job description

Your Role

The Blue Shield of California Promise Health Plan Growth & Retention team is looking for an Enrollment and Retention Specialist who will educate and assist callers with the Medi-Cal enrollment process as it pertains Medi-Cal eligibility and plan enrollment to achieve new enrollment and member retention goals. In this role you will also assist members with the annual Medi-Cal redetermination process, advocate for callers with internal departments as well as County and State agencies and supports other growth projects. Adherence to all compliance requirements and maintaining appropriate documentation is essential to this role. The Blue Shield Promise Growth & Retention team reports to the Growth & Retention Supervisor.

Job Description

Your Role

The Blue Shield of California Promise Health Plan Growth & Retention team is looking for an Enrollment and Retention Specialist who will educate and assist callers with the Medi-Cal enrollment process as it pertains Medi-Cal eligibility and plan enrollment to achieve new enrollment and member retention goals. In this role you will also assist members with the annual Medi-Cal redetermination process, advocate for callers with internal departments as well as County and State agencies and supports other growth projects. Adherence to all compliance requirements and maintaining appropriate documentation is essential to this role. The Blue Shield Promise Growth & Retention team reports to the Growth & Retention Supervisor.

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.

Responsibilities

Your Work

In this role, you will:

• Handle independently day-to-day growth and retention calls meeting all department performance standards
• Provide comprehensive eligibility and enrollment information to callers to identify best BSC product
• Work independently to facilitate member enrollment by working with Federal, State and Local County agencies escalating complex cases as needed
• Work with existing BSC members to help them stay in any BSC product
• Take the initiative to help callers with cases by conducting thorough follow-up assistance and utilizing and managing tracking systems
• Enter timely and precise documentation in all required systems adhering to department guidelines to ensure accurate reporting
• Interact with members via telephone to educate and conduct various call campaigns
• May assist with testing new processes/procedures and system enhancements

Qualifications

Your Knowledge and Experience

• Requires a High School Diploma or GED or 1 year of additional relevant experience in lieu of a diploma
• Requires at least 3 years of prior relevant experience
• Requires strong knowledge of the Medi-Cal program and Managed Care products/services
• Requires being Bilingual in Spanish
• Requires maintaining active compliance certifications

Hybrid Virtual Work

This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.

About Us

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.

Our Workplace Model

We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:

• For most teams, this means coming into the office two days per week.
• Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
• For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.

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.

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.

JOB INFO

Job Schedule : Full time

Locations :

Long Beach, CA, United States

Woodland Hills, CA, United States

Pay Range for California : $21.73 to $30.43

Pay Range for Bay Area : $24.50 to $34.31

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 experience, location (California, Bay Area, or outside California), and current employee salaries for similar roles.

Role can be filled by a candidate requiring sponsorship : No