Appeals Intake Specialist

Blue Cross and Blue Shield of North Carolina

2d • Remote

About The Position

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. • 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)

Requirements

• High school diploma or GED
• 3+ years of experience in related field.

Responsibilities

• 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)

Benefits

• 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.
• Much more than a paycheck
• The total value of working at Blue Cross NC goes far beyond your paycheck.
• We offer benefits and perks that help you thrive, such as competitive health benefits, bonus plans based on performance, 401(k) with employer match, paid time off (plus two well-being days), and a variety of career development and wellness programs.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED