Intake Specialist

Blue Cross NC; Raleigh; Hybrid; CAD 59,000 - 95,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

401k match

Paid time off

Job summary

Blue Cross NC is hiring an Intake Specialist to join the Commercial UM Operations Team. Based on established guidelines, the Intake Specialist processes internal and external member/provider requests and transactions, screens and enters data for review, and supports timeliness and reduces unpaid claims and rework.

You will work within a Hybrid Flex environment, with remote options and in-person collaboration, and you will address inquiries with a focus on accuracy and service excellence.

Qualifications

• High school diploma or GED.
• 3+ years of experience in related field.

Responsibilities

• Process a variety of requests, inquiries and transactions via phone, email, fax, and mail
• Review requests to ensure accuracy
• Support internal & external customers via phone or email
• Document all pertinent information related to the call/inquiry, attach supporting information as applicable and route unresolved items for follow up
• Gather and analyze data to provide feedback to Team Leads on employee development needs and/or education for providers
• Screen inquiries to determine if authorization is required
• Verify member benefits and eligibility and/or provider setup
• Maintain and update Service Requests and research incorrect or missing information
• Triage and assign all incoming inquiries to appropriate staff
• Perform Peer Audits monthly
• Provide clinical review outcome notification to members and providers

Skills

Telephone-based customer service

Medical terminology

Education

High school diploma or GED

Job description

Job Description

We’re hiring an Intake Specialist to join the Commercial UM Operations Team! Based on established guidelines, the Intake Specialist processes a variety of internal and external member/provider requests and transactions,. Receives, screens, and enters data in preparation for review. Complies with timeliness standards and reduces unpaid claims and rework by accurately processing requests. May also assist on special projects as needed.

Job Description

We’re hiring an Intake Specialist to join the Commercial UM Operations Team! Based on established guidelines, the Intake Specialist processes a variety of internal and external member/provider requests and transactions,. Receives, screens, and enters data in preparation for review. Complies with timeliness standards and reduces unpaid claims and rework by accurately processing requests. May also assist on special projects as needed.

What You’ll Do

• Process a variety of requests, inquiries and transactions via phone, email, fax, and mail
• Review requests to ensure accuracy
• Support internal & external customers via phone or email
• Document all pertinent information related to the call/inquiry, attach supporting information as applicable and if unable to resolve route to appropriate area for follow up as applicable
• Gather and analyze data to provide feedback to Team Leads on employee development needs and/or specific providers requiring education on prior approval or pre-certification process
• Screen inquiries to determine if authorization is required
• Verify member benefits and eligibility and/or provider setup.
• Maintain and update Service Requests and research incorrect or missing information.
• Triage and assign all incoming inquiries in a timely, efficient manner throughout the day to appropriate staff
• Perform Peer Audits monthly as required
• Provide clinical review outcome notification to members and providers (verbal and written)

What You Bring

• High school diploma or GED
• 3+ years of experience in related field.

At this time, Blue Cross NC will not sponsor employment authorization for this position.

Bonus Points (Preferred Qualifications)

• Prior telephone-based customer service experience strongly preferred.
• Familiarity with and understanding of medical terminology is a plus.

What You’ll Get

• The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community
• Work-life balance, flexibility, and the autonomy to do great work
• Medical, dental, and vision coverage along with numerous health and wellness programs
• Parental leave and support plus adoption and surrogacy assistance
• Career development programs and tuition reimbursement for continued education
• 401k match including an annual company contribution
• Learn more

Where You’ll Work

Our Hybrid Flex approach is built on presence with a purpose – giving you flexibility to work remotely with intentional in‑person connection – that supports a workplace that’s flexible, connected, and future focused.

In a Hybrid‑Flex role, you’ll work in the office at least two days a week for collaboration and connection. In a Remote Flex role, you’ll work virtually, with a few in‑office visits each year for meaningful moments that matter.

Whether your role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any states listed on this job posting. Onsite expectations will be discussed during the interview process.

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

• Based on annual corporate goal achievement and individual performance.

$41,600.00 - $66,561.00

Skills

_____________________________________________________________________