Intake & Eligibility Specialist — Hybrid/Remote

BCBSNC; United States; Hybrid; USD 42,000 - 67,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Parental leave and surrogacy/adoption.

Tuition reimbursement and career发展

Job summary

Blue Cross NC is hiring an Intake Specialist to join the Commercial Pharmacy & UM Operations team. Based on established guidelines, the Intake Specialist processes a variety of internal and external member/provider requests and transactions, screens data, and prepares for review while complying with timeliness standards to reduce unpaid claims.

We offer a hybrid-flex environment with in-person collaboration and remote work options.

Qualifications

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

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 for follow up as needed.
• Gather and analyze data to provide feedback to Team Leads on development needs and/or providers needing education on prior approval or pre-certification.
• 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.
• Perform Peer Audits monthly as required.
• Provide clinical review outcome notification to members and providers.

Skills

Customer Service

Data Entry

Time Management

Scheduling

Communication

Education

High School Diploma or GED

Job description

Blue Cross NC is hiring an Intake Specialist to join the Commercial Pharmacy & UM Operations team. Based on established guidelines, the Intake Specialist processes a variety of internal and external member/provider requests and transactions, screens data, and prepares for review while complying with timeliness standards to reduce unpaid claims.

We offer a hybrid-flex environment with in-person collaboration and remote work options.