Health Services Intake Specialist (Remote eligible after onsite training)

Wellmark, Inc. • Des Moines, IA

2d • Remote

About The Position

The Health Services Intake Specialist works in a call center setting, facilitating care management functions such as eligibility and benefit verification, authorization-status inquiries, data collection and documentation, and the accurate completion of precertification and notification requests. The role provides administrative support to care management teams and helps meet corporate and department objectives by processing incoming care management requests promptly, professionally, and courteously.

The position requires six weeks of training at Wellmark’s Des Moines, Iowa office. After successful completion of training, the employee is eligible to work remotely on weekdays or follow a hybrid office/home schedule, depending on preference. Remote eligibility may change based on business needs, and occasional office attendance may be requested for meetings or other important events.

Requirements

• High school diploma or GED.
• At least 1 year of related experience, including customer or provider service experience; developing customer relationships by telephone; obtaining necessary information and accurately documenting conversations; and experience in the health insurance or health care industry.
• Experience working in a production environment with production and quality metrics.
• Ability to apply critical thinking to resolve issues and conflicts while maintaining composure and confidence.
• Ability to prioritize work and meet deadlines.
• Strong written and verbal communication skills, including the ability to communicate effectively with varied audiences.
• Proficiency with Microsoft Office applications.
• Excellent attendance and punctuality.
• Comfort working in a high-volume, fast-paced call center environment.

Responsibilities

• Verify member eligibility and benefits, as well as provider participation and network status.
• Accurately and promptly document information received by phone, fax, or provider portal in JIVA, following department guidelines.
• Support Nurse Care Managers by manually creating episodes for services and admissions to be reviewed for medical necessity.
• Create and send letters to providers and/or members communicating authorization request outcomes.
• Manage workload within regulatory turnaround requirements and mandated case-processing timeframes.
• Provide accurate information to members and providers using current guidelines and job aids, and meet Health Services quality assurance and production metrics.
• Accurately interpret and follow regulatory and accreditation standards, Health Services guidelines, and HIPAA requirements.
• Remain current with and comply with standards and internal guidelines relevant to utilization management services.
• Perform other duties as assigned.

What This Job Offers

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