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Health Services Intake Specialist – Remote eligible after onsite training
Wellmark Blue Cross and Blue Shield. Facilitate care management functions in a call center setting .
About the role
Key responsibilities & impact- Facilitate care management functions in a call center setting
- Verify member eligibility and benefits
- Verify provider participation and network status
- Process eligibility, authorization status inquiries, data collection, documentation, precertification, and notification requests
- Provide administrative support to care management teams
- Document information received by phone, fax, or provider portal in JIVA
- Manually create episodes for services and admissions for Nurse Care Manager medical-necessity review
- Create and send letters to providers and members communicating authorization request outcomes
- Manage workload within regulatory turnaround requirements and mandated processing timeframes
- Provide accurate information using current guidelines and job aids
- Meet Health Services quality assurance and production metrics
- Interpret and comply with regulatory, accreditation, HIPAA, Health Services, and internal standards
- Perform other duties as assigned
Requirements
What you’ll need- High School Diploma or GED
- 1+ years of related experience, including customer or provider service experience
- Experience developing customer relationships via telephone
- Experience obtaining necessary information and accurately documenting conversations
- Health insurance or health care industry experience
- Experience working within a production environment with production and 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
- Proficiency with Microsoft Office applications
- Excellent attendance and punctuality
- Comfortable working in a high-volume, fast-paced call center environment
- Must not require immigration sponsorship or additional/permanent work authorization now or in the future to work in the United States
Benefits
Comp & perks- Remote work eligibility after successful six-week onsite training
- Option to work fully remote each weekday or follow a hybrid office/home schedule
- Option to come into a Wellmark office depending on location
- Occasional office attendance for specific meetings or other “moments that matter”
- Reasonable accommodation support for applicants with disabilities
- Responsible use of AI tools welcomed during the application process