Senior Managed Care & Case Coordination Specialist

United States Digital Space LLC; United States; Remote; USD 50,000 - 67,000; Full time

Benefits offered by this job

Comprehensive health benefits

Retirement Plans

Generous PTO

Incentive Plans

Wellness Programs

Paid Volunteer Time Off

Tuition Reimbursement

Job summary

Horizon BCBSNJ is seeking a Clinical Operations support role to liaison among members, physicians, delegates, and case managers. You will lead non-clinical teams, handle escalated issues, and coordinate benefits and treatments.

The role includes onboarding new coordinators, translating documents between English and Spanish, and ensuring accuracy in clinical/non-clinical data. Strong communication and health-insurance knowledge are essential.

Qualifications

• High School Diploma/GED required.
• 3-5 years customer service experience.
• Medical certification translator education.
• Knowledge of medical terminology.
• Good oral and written communication skills.
• Ability to make sound decisions under supervision.
• Prefers knowledge of contracts, enrollment, billing & claims processing.

Responsibilities

• Review service requests for completeness and gather non-clinical data.
• Prepare and route cases for clinical review in the appropriate system.
• Initiate callbacks to members and providers to verify benefits.
• Triage and answer inquiries; coordinate care and case management.
• Translate clinical and non-clinical documents between English and Spanish.
• Assist onboarding and training of new Managed Care Coordinators.
• Provide liaison between providers, members, and Care Managers.

Skills

Bilingual English/Spanish

Medical terminology

Communication skills

Caseload coordination

Education

High School Diploma/GED

Medical translation certification

Job description

Horizon BCBSNJ is seeking a Clinical Operations support role to liaison among members, physicians, delegates, and case managers. You will lead non-clinical teams, handle escalated issues, and coordinate benefits and treatments.

The role includes onboarding new coordinators, translating documents between English and Spanish, and ensuring accuracy in clinical/non-clinical data. Strong communication and health-insurance knowledge are essential.