Health Services Intake Specialist (Remote eligible after onsite training)

Wellmark, Inc.; Iowa; Remote; USD 42,000 - 56,000; Full time

Job summary

Wellmark, Inc. is seeking a Health Services Intake Specialist to support care management in a fast-paced call center. The role focuses on eligibility and benefits verification, precertification, and documentation to support care management teams.

The position includes training for six weeks in Des Moines, IA, after which remote work options may be available based on business needs. This opportunity emphasizes member advocacy, accuracy, and collaboration with multidisciplinary teams.

Qualifications

• High School Diploma or GED.
• 1+ years of related experience including customer or provider service experience.
• Experience working in a production environment with production & quality metrics.
• Demonstrated ability to apply critical thinking to resolve issues while maintaining composure.
• Ability to prioritize work and meet deadlines.
• Strong written and verbal communication skills with the ability to communicate to varying audiences.
• Proficiency with Microsoft Office applications.
• Excellent attendance and punctuality.
• Comfortable working in a high volume, fast paced call center environment.

Responsibilities

• Verify member eligibility and benefits as well as provider participation and network status.
• Perform accurate, timely documentation of information received via phone, fax, or provider portal within JIVA.
• Support the Nurse Care Managers by creating episodes for services and admissions to be reviewed for medical necessity.
• Manage workload within regulatory turnaround time requirements and mandated timeframes for processing cases.
• Provide accurate information to members and providers by utilizing guidelines and job aides.
• Demonstrate understanding of regulatory standards, Health Services guidelines, and HIPAA requirements.
• Comply with regulatory and accreditation standards relevant to utilization management services.
• Other duties as assigned.

Skills

Customer service

Phone communication

Documentation

Microsoft Office

Time management

Education

High School Diploma or GED

Tools

JIVA

Job description

Why Wellmark:

We are a mutual insurance company owned by our policy holders across Iowa and South Dakota, and we’ve built our reputation on over 80 years’ worth of trust. We are not motivated by profits. We are motivated by the well-being of our friends, family, and neighbors–our members. If you’re passionate about joining an organization working hard to put its members first, to provide best-in-class service, and one that is committed to sustainability and innovation, consider applying today!

Learn more about our unique benefit offerings here.

About the Role:

We’re looking for a Health Services Intake Specialist to work within a call center setting facilitating care management functions, including eligibility and benefit verification, authorization status inquiries, data collection/documentation and accurate completion of precertification and notification requests. This individual will provide administrative support to care management teams and contribute to corporate and department objectives by processing incoming care management requests in a prompt, professional and courteous manner.

About You:

Are you excited about the opportunity to advocate for stakeholders through collaboration with multi-disciplinary teams? Are you able to manage a large variety of responsibilities while staying organized? Do you enjoy researching within guideline documentation and making decisions based on what you find? If you are a dedicated, customer-focused health care professional motivated and inspired by the opportunity to provide administrative support to care management teams in a fast-paced production environment, consider applying today!

This role will require training for the first 6 weeks from our Des Moines, Iowa office. After a successful training period, you will be eligible to work remotely each weekday*, or a hybrid office/home schedule based on your preference.

*Remote eligibility subject to change based on business needs.

Required Qualifications:

• High School Diploma or GED.
• 1+ years of related experience including customer or provider service experience, including experience developing customer relationships via telephone, obtaining necessary information and accurately documenting conversations and health insurance or health care industry experience.
• Experience working within a production environment with production & quality metrics.
• Demonstrated ability to apply critical thinking to resolve issues and conflicts while maintaining composure and confidence.
• Ability to prioritize work and meet deadlines.
• Strong written and verbal communication skills with the ability to effectively communicate to varying audiences.
• Proficiency with Microsoft Office applications.
• Excellent attendance and punctuality.
• Must be comfortable working in a high volume, fast paced call center environment.

What you will do as a Health Services Intake Specialist:

a. Verify member eligibility and benefits as well as provider participation and network status.
b. Perform accurate, timely documentation of information received via phone, fax, or provider portal within JIVA. Ensure accuracy of information through strong communication skills and adherence to department guidelines.
c. Support the Nurse Care Managers by manually creating episodes for services and admissions that will be reviewed for medical necessity. Create and send letters to providers and/or members to communicate authorization request outcomes.
d. Manage workload within regulatory turnaround time requirements and mandated timeframes for processing cases.
e. Provide accurate information to members and providers by utilizing up to date guidelines and job aides. Meet both quality assurance and production metrics established by the Health Services department.
f. Demonstrate understanding and accurate interpretation of regulatory and accreditation standards, Health Services guidelines, and HIPAA requirements.
g. Comply with regulatory standards, accreditation standards and internal guidelines; remains current and consistent with the standards pertinent to utilization management services.
h. Other duties as assigned.

Remote Eligible:

You will have the flexibility to work where you are most productive. This position is eligible to work fully remote. Depending on your location, you may still have the option to come into a Wellmark office if you wish to. Your leader may ask you to come into the office occasionally for specific meetings or other ‘moments that matter’ as well.

An Equal Opportunity Employer

The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.

Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at [e-mail]

Please inform us if you meet the definition of a "Covered DoD official".

At this time, Wellmark is not considering applicants for this position that require any type of immigration sponsorship (additional work authorization or permanent work authorization) now or in the future to work in the United States. This includes, but IS NOT LIMITED TO: F1-OPT, F1-CPT, H-1B, TN, L-1, J-1, etc. For additional information around work authorization needs please refer to the following resources: Nonimmigrant Workers and Green Card for Employment-Based Immigrants

Wellmark supports and expects the responsible use of AI for our workforce! We welcome the responsible use of these tools by job seekers as well and are interested in learning from you; you will have an opportunity in the application process to share which tools you used and how you applied them.