Pre-Certification Specialist

Processing precertification requests in a fully remote capacity, the Pre-Certification Specialist will manage high-volume calls from members and healthcare professionals, verify eligibility, and ensure compliance with state and federal regulations. Key responsibilities Answer incoming calls regarding precertification requests and verify member eligibility using multiple systems Process precertification requests and obtain necessary clinical information while adhering to departmental guidelines Identify requests for medical necessity reviews and ensure compliance with corporate quality standards Required qualifications High school diploma required; associate degree in a related field preferred A minimum of three years of customer service experience in the health insurance or health services industry Knowledge of medical terminology and familiarity with ICD9/ICD10 and CPT codes Experience with computerized databases, including Word, Excel, and Mainframe Knowledge of INSINQ is a plus