Care Management Specialist II

Premera Blue Cross

. Perform intake of inpatient and outpatient service requests .

Posted 10/5/2026full-timeRemote • United StatesJunior💰 $48,400 - $72,600 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates proficiency in managing service requests and providing customer support in a healthcare environment, utilizing tools like Facets and Jiva while adhering to regulatory standards. Capable of effective communication and collaboration with clinical staff and team members to enhance service delivery.

Highest-signal resume keywords

Customer Service ExperienceFacets System ProficiencyJiva System ProficiencyMedical Terminology KnowledgeRegulatory Standards Application

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Service Request ManagementData ProcessingCase ScreeningMedical TerminologyTime Management

Soft Skills

Effective CommunicationOrganizational SkillsStress ManagementTeam CollaborationProblem-Solving

Tools & Technologies

Microsoft Office OutlookMicrosoft WordOffice CommunicatorLive MeetingExcel

Certifications & Qualifications

High School DiplomaGED

Industry Keywords

Inpatient ServicesOutpatient ServicesCustomer ServiceHealthcare ComplianceAccreditation Standards

About the role

Key responsibilities & impact

Perform intake of inpatient and outpatient service requests
Provide information to external customers and medical professionals regarding medical service inquiries
Manage all lines of business, including national accounts, self-insured, and fully-insured plans
Manage incoming service requests via fax and electronic submission using Facets and Jiva
Serve as a resource for customer service representatives on unresolved medical inquiries
Triage and consult with clinical staff as appropriate
Process and load information for inpatient notifications, discharges, pre-service requests, and outpatient services using Facets, Jiva, and Appian
Apply regulatory and accreditation standards
Follow scripted clinical criteria and use medical terminology to collect data, conduct initial case screening, and process requests without clinical evaluation or interpretation
Handle specialized and complex account-specific needs
Identify system and provider issues and trends, recommend process changes, and lead improvement initiatives
Assist in training and supporting new team members

Requirements

What you’ll need

High School Diploma or GED (Required)
One (1) year of experience in a customer service-oriented environment (Required)
Associate degree in medically related field (Preferred)
One (1) year of experience with Premera systems and tools (Preferred)
Demonstrated effective written and verbal skills with the ability to communicate professionally
Demonstrated effective telephone skills
Effective time management, organization and prioritization skills
Ability to handle stressful situations, work in a high production environment and follow through on assigned tasks
Ability to work independently and as a member of a team
Ability to work flexible hours to meet specific work demands
Intermediate skills with Microsoft Office Outlook, Word, Office Communicator, and Live Meeting
Familiarity with Excel
Basic knowledge of medical terminology
Ability to commit to a permanent schedule working both Saturdays and Sundays

Benefits

Comp & perks

Medical, vision, and dental coverage with low employee premiums
Voluntary benefit offerings, including pet insurance
Life and disability insurance
Retirement programs, including a 401K employer match and a pension plan vested after 3 years of service
Wellness incentives, including mental well-being resources, counseling services, stress management programs, and mindfulness programs
Generous paid time off
Tuition assistance for undergraduate and graduate degrees
Employee recognition program
Commuter perks
Free convenient on-site parking
Subsidized on-campus cafes
On-site health and wellness activities
Fitness and well-being center with in-person and virtual workouts and nutritional counseling
Flexible routine and access to on-site resources, networking opportunities, and team engagement for hybrid employees