BlueCard Multi Service Specialist I or II, DOE
Cambia Health Solutions

Job Info

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BlueCard Multi Service Specialist I or II, DOE

Remote within WA, ID, OR, and UT

Primary Job Purpose:

The BlueCard Multi Service Specialist provides information, education and assistance by entry, activation or billing of individual subscribers and group accounts, according to benefits contract.

Responsibilities:

• Connect with providers, group administrators, and other member representatives and internal staff for questions regarding claim payments and denials, decisions, and other information through a variety of media - oral, written and online communications. Respond to multiple inquiries on all designated lines of business.
  
• Quickly and accurately assess provider inquiries and requirements by establishing a rapport with the other person to better understand their service needs.
  
• Identify errors promptly and figure out which corrective steps should be taken to resolve any errors.
  
• Make appropriate corrections of denied, process-in-error or re-classified claims.
  
• Document inquiries and actions both online by completing logs.
  
• Explain complex benefits, rules of eligibility and claims payment procedures, pre-authorizations, medical review and referrals, and grievance/appeal procedures to providers to ensure that benefits, policies and procedures are understood.
  
• Educate providers on confusing terminology and policies such as eligible medical expenses, hold harmless, medical necessity, contract exclusions and limitations, and managed care products.
  
• Settle benefit payments, maximum allowable fees, co-pays, and deductibles from appropriate contracts.
  
• Maintain confidentiality and sensitivity when interacting both internally and externally.
  
• Handle high-volume of calls daily, prioritize follow-through, and provide timely response and follow-up on outstanding issues. May generate written correspondence and process document requests.
  
• Accurately apply contract benefits within guidelines and recognize incomplete or inappropriate claims. Make decisions regarding the disposition of claim; may include payment/denial of claim or request for further medical review, provider fee audit, medical record(s) and/or accident reports.
  
• Apply knowledge of medical terminology, ICD-10, CPT coding and other resources to resolve claim issues.
  
• Adapt to changes that impact the job, including contract changes as well as procedure or system changes to ensure accurate claims processing.
  
• Manually process claims that are not eligible for auto-processing.
  
• Handle general inquiries, appeals, and adjustments generated by calls, correspondence, and new bills.
  
• Keep all documents, policies, procedures and guidelines updated and readily accessible.
  
• Maintain confidentiality in all aspects of processing and appeals.
  
• Align with MTM and Consortium standards as they relate to the employee's responsibility to meet BlueCross BlueShield Association (BCBSA) standards and company goals.
  
• Work overtime and on weekends as needed.
  
• Complete assigned projects and duties, as well as special projects or reports, as requested by management.
  

Minimum Requirements:

• At least one year experience in Claims or Membership, and Call Center Customer Service experience required.
  
• PC experience and familiarity with company software, such as Word and Excel.
  
• Excellent interpersonal skills and the ability to communicate clearly and concisely, verbally and in writing.
  
• Ability to work independently with a minimum supervision.
  
• Ability to listen and communicate appropriately with provider community, member representatives, and coworkers in a manner that promotes positive, professional interaction while maintaining member/provider confidentiality.
  
• Ability to make decisions and exercise good judgment.
  
• Ability to coordinate and prioritize workload to meet deadlines.
  

Work Environment:

• May sit and key at PC for extended periods of time.
  

Regence employees are part of the larger Cambia family of companies, which seeks to drive innovative health solutions. We offer a competitive salary and a generous benefits package. We are an equal opportunity employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

Regence is 2.2 million members, here for our families, co-workers and neighbors, helping each other be and stay healthy and provide support in time of need. We've been here for members for 100 years. Regence is a nonprofit health care company offering individual and group medical, dental, vision and life insurance, Medicare and other government programs as well as pharmacy benefit management. We are the largest health insurer in the Northwest/Intermountain Region, serving members as Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (in Washington). Each plan is an independent licensee of the Blue Cross and Blue Shield Association.

If you're seeking a career that affects change in the health care system, consider joining our team at Cambia Health Solutions. We advocate for transforming the health care system by making health care more affordable and accessible, increasing consumers' engagement in their health care decisions, and offering a diverse range of products and services that promote the health and well-being of our members. Cambia's portfolio of companies spans health care information technology and software development; retail health care; health insurance plans that carry the Blue Cross and Blue Shield brands; pharmacy benefit management; life, disability, dental, vision and other lines of protection; alternative solutions to health care access and free-standing health and wellness solutions.

Information about how Cambia Heath Solutions collects, uses, and discloses information is available in our Privacy Policy.

This position includes 401(k), healthcare, paid time off, paid holidays, and more. For more information, please visit www.cambiahealth.com/careers/total-rewards.

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.

This job has expired.