Care Management Specialist II

Job not on LinkedIn

🔥 0 minutes ago

🐻 Alaska, Arizona, +25 more states – Remote

🐻 Alaska – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🌶️ New Mexico – Remote 🌲 North Carolina – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🏰 Missouri – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote ☕ Washington – Remote 🧀 Wisconsin – Remote

💵 $48.4k - $72.6k / year

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Premera Blue Cross

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1945

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Premera Blue Cross is an independent health insurance provider, serving businesses and residents of Washington State and Alaska as a licensee of the Blue Cross Blue Shield Association. The company offers a range of health plans including individual, family, employer-based, and Medicare Supplement plans. However, it has announced that it will exit the Medicare Advantage market as of January 1, 2025. Premera is committed to advancing health equity and community support, evident through its Social Impact Program focused on behavioral health and homelessness solutions in Washington and Alaska. Additionally, Premera complies with federal and state civil rights laws, offering language assistance services to ensure equitable care.

📋 Description

• 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

• 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

• 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