Case Management Coordinator (CMC) – Life & Disability Operations

Alberta Blue Cross; United States; Teletrabalho; USD 42 000 - 68 000; Tempo integral

Resumo da oferta

Alberta Blue Cross® is seeking a temporary (12-month) Case Management Coordinator in the United States to ensure accurate claim intake, validate policy and benefit coverage, and update claim systems across the lifecycle. You will coordinate communications with internal teams and external stakeholders to support plan members and plan administrators.

The role requires related post-secondary education and strong MS Office skills.

Qualificações

• Related post-secondary education.
• Must possess excellent knowledge and experience with Microsoft Word, Access, Excel, and PowerPoint.
• Keen attention to detail.
• Strong analytical skills.
• Excellent verbal and written communication skills.
• Must demonstrate strong organizational skills.
• Must be able to work well under pressure and be able to assess priorities in a confident manner.
• Must be flexible, innovative and independent.
• Must work effectively with fellow employees and staff from other departments in a team focused atmosphere.
• Experience with database management is an advantage.

Responsabilidades

• Ensure all intake forms are filed accurately and maintained confidentially.
• Validate member information, census data, salary, and eligibility for accurate claim processing.
• Coordinates with Group Administration to enroll members in their benefits.
• Accurately create claim intakes in designated claim and reporting systems, maintaining compliance with processing standards.
• Set up required tasks to support claim intake and ongoing maintenance.
• Respond to telephone inquiries from plan members, beneficiaries and plan administrators.
• Contacts and follows up as required with plan members, beneficiaries, plan administrators and treating health care providers to obtain required information.
• Update claims throughout their lifecycle in claim systems, ensuring timely upload of all incoming documentation and correspondence from multiple submission channels (mail, email, fax, online) to support accurate adjudication.
• Gather and prepare confidential documentation for plan members, plan administrators, physicians, treatment providers, lawyers, and other stakeholders.
• Communicate with internal departments (Medical Underwriting, Group Underwriting, Sales, Group Administration, Payment team) to exchange information on claims, eligibility, and financial transactions.
• Work collaboratively with Case Managers, Adjudicators, and Payment Specialists on CPPD recoveries, including creating initial packages, follow-ups, and letters.

Conhecimentos

Analytical skills

Attention to detail

Verbal and written communication

Organizational skills

Ability to work under pressure

Team collaboration

Independent worker

Formação académica

Related post-secondary education

Ferramentas

Microsoft Word

Microsoft Access

Microsoft Excel

Microsoft PowerPoint

Descrição da oferta de emprego

Alberta Blue Cross® is an Alberta based organization dedicated to delivering exceptional customer experience and community leadership. We’re committed to providing the best health coverage to over 1.8 million members and take an active role in promoting wellness. We believe in what we do—and place trust in our employees to deliver our vision.

Working at Alberta Blue Cross® means having a career where you’ll be recognized for your contributions. We value diversity, encourage our team members to maintain a healthy work-life balance and provide opportunities for career growth.

OVERVIEW:

We are continuing to grow our team and are looking for a temporary (12-month) Case Management Coordinator (CMC). In this role, you will ensure accurate claim intake and maintenance, validating policy and benefit coverage, and updating claim systems throughout the claim lifecycle. You will coordinate communications with internal teams and external stakeholders, while providing responsive support to plan members, beneficiaries, and plan administrators.

WHAT YOU WILL DO:

• Ensure all intake forms are filed accurately and maintained confidentially.
• Validate member information, census data, salary, and eligibility for accurate claim processing.
• Coordinates with Group Administration to enroll members in their benefits.
• Accurately create claim intakes in designated claim and reporting systems, maintaining compliance with processing standards.
• Set up required tasks to support claim intake and ongoing maintenance.
• Respond to telephone inquiries from plan members, beneficiaries and plan administrators.
• Contacts and follows up as required with plan members, beneficiaries, plan administrators and treating health care providers to obtain required information.
• Update claims throughout their lifecycle in claim systems, ensuring timely upload of all incoming documentation and correspondence from multiple submission channels (mail, email, fax, online) to support accurate adjudication.
• Gather and prepare confidential documentation for plan members, plan administrators, physicians, treatment providers, lawyers, and other stakeholders.
• Communicate with internal departments (Medical Underwriting, Group Underwriting, Sales, Group Administration, Payment team) to exchange information on claims, eligibility, and financial transactions.
• Work collaboratively with Case Managers, Adjudicators, and Payment Specialists on CPPD recoveries, including creating initial packages, follow-ups, and letters.

WHAT YOU WILL HAVE:

• Related post-secondary education.
• Must possess excellent knowledge and experience with Microsoft Word, Access, Excel, and PowerPoint.
• Keen attention to detail.
• Strong analytical skills.
• Must possess excellent verbal and written communication skills.
• Must demonstrate strong organizational skills.
• Must be able to work well under pressure and be able to assess priorities in a confident manner.
• Must be flexible, innovative and independent.
• Must work effectively with fellow employees and staff from other departments in a team focused atmosphere.
• Must demonstrate excellent interpersonal skills.
• Experience with database management is an advantage.

This position will remain open until a suitable candidate is selected.

Alberta Blue Cross® is an inclusive employer committed to a workplace that reflects the diversity of the communities we serve. We empower and are advocates for our team members by welcoming, respecting and valuing their unique perspectives, backgrounds, and experiences.

We offer the opportunity to work in an innovative, high-energy team-focused environment.

A criminal record check satisfactory to Alberta Blue Cross will be required as a condition of employment, following a conditional offer.