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Capital Blue CrossPosted 10/21/2026full-timeRemote • Pennsylvania • United StatesJuniorMid-Level💰 $19 - $35 per yearWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates proficiency in administrative support within clinical settings, including utilization management and case management, while ensuring compliance with regulatory standards. Exhibits strong organizational skills and effective communication abilities to enhance member and provider interactions.
Highest-signal resume keywords
Medical Management System ProficiencyUtilization Management ExperienceKnowledge of Regulatory StandardsMicrosoft Office ProficiencyMedical Terminology Knowledge
About the role
Key responsibilities & impact- Provides administrative support to the assigned clinical team under the direction of the Team Lead and/or Manager
- Performs administrative tasks supporting clinical processes such as utilization management, case management, and population health management
- Builds medical management records, including authorizations and referral management
- Monitors compliance reports
- Completes member and provider communications
- Assists with medical record documentation requests
- Uses the medical management system to initiate cases and authorizations
- Conducts fax, telephone, and written outreach to members and providers
- Supports administrative functions at community events such as health fairs
- Documents interventions accurately in member medical management records
- Supports department compliance and performance through report monitoring and distribution
- Adheres to regulatory, compliance, and department policies and procedures
- Interacts professionally with internal staff, vendor partners, providers, and members
- Identifies and reports potential quality-of-service and quality-of-care issues
- Participates in staff meetings, in-services, and corporate training
- Identifies opportunities and proposes alternatives to improve Population Management functions
Requirements
What you’ll need- Minimum 2 years’ experience in the medical field (e.g. medical assistant, medical secretary) or 2 years’ experience in a managed care clinical department
- High School Diploma required
- Continued higher education preferred
- Strong organizational and time management skills
- Strong attention to detail and accuracy
- Ability to follow departmental policies and procedures
- Excellent written and oral communication skills
- Working knowledge and operation of a personal computer
- Proficiency in Microsoft Office applications
- Working knowledge of medical terminology
- Working knowledge of the health insurance industry, health plan benefits, and product lines
- Knowledge of regulatory and accreditation standards and requirements, including NCQA and CMS
Benefits
Comp & perks- Medical coverage
- Dental coverage
- Vision coverage
- Retirement Plan
- Paid Time Off
- Holidays
- Volunteer time off
- Incentive Plan
- Tuition Reimbursement
- Flexible work environment
- Training and continuing education
- Community volunteering opportunities
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Utilization ManagementCase ManagementPopulation Health ManagementMedical Record DocumentationCompliance MonitoringAuthorization ManagementReport MonitoringQuality-of-Service IdentificationHealth Plan Benefits KnowledgeRegulatory Compliance
Soft Skills
Organizational SkillsTime ManagementAttention to DetailWritten CommunicationOral Communication
Tools & Technologies
Medical Management SystemPersonal ComputerMicrosoft Office Applications
Industry Keywords
Managed CareHealth Insurance IndustryNCQACMSAccreditation Standards