Clinical Support Specialist (Fully Remote)

Capital Blue Cross; United States; Remote; USD 25,000 - 36,000; Full time

Job summary

Capital Blue Cross is seeking a detail-oriented administrative support professional to assist with medical record documentation requests and to coordinate UM/CM case initiations using the medical management system.

The role covers communications with members and providers about UM/CM status, supports administrative tasks for community events, and ensures precise documentation of interventions while contributing to compliance and performance through report monitoring and assigned tasks.

Qualifications

• Minimum 2 years experience in the medical field or managed care.
• High School Diploma required; continued education preferred.
• Strong organizational, time management, and communication skills.
• Working knowledge of medical terminology and health insurance industry.

Responsibilities

• Assist with medical record documentation requests and leverage medical management system to initiate case/authorizations.
• Conduct fax, telephone, and written communications to members/providers regarding UM/CM status.
• Support administrative functions for community events and accurately document interventions.
• Supports compliance and performance through report monitoring and assigned tasks.
• Promotes personal growth through training and corporate development.

Skills

Microsoft Office

Medical terminology

Health insurance

Education

High School Diploma

Job description

• Assist with medical record documentation requests and leverage medical management system to initiate case/authorizations.
• Conduct fax, telephone, and written communications to members/providers regarding UM/CM status.
• Support administrative functions for community events and accurately document interventions.

Qualifications:

• Minimum 2 years experience in the medical field or managed care clinical department.
• High School Diploma required; continued education preferred.
• Strong organizational, time management, and communication skills.

Skills and Knowledge:

• Proficient in Microsoft Office applications.
• Working knowledge of medical terminology and health insurance industry.
• Knowledge of regulatory and accreditation standards (e.g., NCQA, CMS).

About the Role:

• Remote position based in Pennsylvania.
• Supports compliance and performance through report monitoring and assigned tasks.
• Promotes personal growth through training and corporate development.

Capital Blue Cross

Capital Blue Cross is a health insurance provider dedicated to improving the health and well-being of its members and communities. They are recognized as one of the "Best Places to Work in PA" with a culture focused on support, flexibility, and community involvement.