Intake Specialist

Job description

Job Description

We're hiring an Intake Specialist to join the Commercial UM Operations Team! Based on established guidelines, the Intake Specialist processes a variety of internal and external member/provider requests and transactions,. Receives, screens, and enters data in preparation for review. Complies with timeliness standards and reduces unpaid claims and rework by accurately processing requests. May also assist on special projects as needed. At Blue Cross NC, we're making health care better for all - by listening deeply, challenging what's possible, and putting care at the heart of everything we do. Join a purpose driven team where ideas spark change, growth is encouraged, collaboration fuels impact, and you're supported with the flexibility and trust to do meaningful work.

What You'll Do

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 if unable to resolve route to appropriate area for follow up as applicable

Gather and analyze data to provide feedback to Team Leads on employee development needs and/or specific providers requiring education on prior approval or pre-certification process

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 throughout the day to appropriate staff

Perform Peer Audits monthly as required

Provide clinical review outcome notification to members and providers (verbal and written)

What You Bring

High school diploma or GED

3+ years of experience in related field.

At this time, Blue Cross NC will not sponsor employment authorization for this position.

Bonus Points (Preferred qualifications)

Prior telephone-based customer service experience strongly preferred.

Familiarity with and understanding of medical terminology is a plus.

WhatYou'llGet

The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community

Work-life balance, flexibility, and the autonomy to do great work

Medical, dental, and vision coverage along with numerous health and wellness programs

Parental leave and support plus adoption and surrogacy assistance

Career development programs and tuition reimbursement for continued education

401k match including an annual company contribution

Learn more

WhereYou'llWork

Our Hybrid Flex approach is builton presencewith a purpose - giving you flexibility to work remotely with intentional in-person connection - that supports a workplacethat'sflexible, connected, and future focused.

In a Hybrid-Flex role,you'llwork in the office at least two days a week for collaboration and connection. In a Remote Flex role,you'llwork virtually, with a few in-office visits each year for meaningful moments that matter.

Whether your role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any states listed on this job posting. Onsite expectations will be discussed during the interview process.

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs.Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

*Based on annual corporate goal achievement and individual performance.

$41,600.00 - $66,561.00 Skills

Accounting, Clinical Evaluations, Clinical Review, Customer Service, Data Entry, Documentations, Inquiry Handling, Job Interviews, Scheduling, Time Management

JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on en-US/BCBSNC. If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: .

Who can apply

Review the original listing for work authorization, qualifications and employer requirements.