Intake Specialist

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. What You’ll Get 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 Where You’ll Work Blue Cross NC is a Hybrid Flex company. Our Hybrid Flex approach is built on presence with a purpose – giving you flexibility to work remotely with intentional in-person connection – that supports a workplace that’s flexible, connected, and future focused. In a Hybrid-Flex role, you’ll work in the office at least two days a week for collaboration and connection. In a Remote Flex role, you’ll work 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 of our approved states: Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming. 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 Authorization to Work in the United States We use E-verify to confirm authorization to work in the United States. To learn more about E-Verify, including your rights and responsibilities, please visit E-Verify Overview for English or Visión General de E-Verify for Español. Request Accommodations Blue Cross NC provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application, hiring process, or have technical issues that prevent you from completing your application please notify HR at View email address on click.appcast.io. #J-18808-Ljbffr Blue Cross and Blue Shield of North Carolina