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SalaryPlease email hr_business_partners@bcbsri.org if you are a candidate seeking a reasonable accommodation for the application and/or interview process.
Schedule: Hybrid or Remote
Compensation: $24.27 - $31.58
Jump into the new world of health insurance:
At Blue Cross & Blue Shield of Rhode Island (BCBSRI), our business is healthcare. But our focus is on improving lives. Be part of a team that is large enough to make a difference but small enough to be innovative. Work in a rapidly changing field. Take a chance to be creative. Move outside the status quo. Shape new ideas with the power of a national brand behind you.
Join others who know diversity is strength:
We appreciate and celebrate everything that makes us unique: age, national origin, citizenship status, perspectives, experiences, physical or mental disability, military status, race, ethnicity, religion, gender, sexual orientation, gender identity and/or expression. Our diversity strengthens us as an organization and helps us better serve an increasingly diverse Rhode Island population.
Why this job matters:
Provide specialized support to clinical staff by responding to member phone calls; facilitate problem resolution and triage calls to appropriate resource. Provide administrative and project support to the department and/or management.
What you will do:
- Respond to inquiries from internal and external customers; facilitate problem resolution through research. Refer call to appropriate resources in a timely manner.
- Interact with clinical staff to obtain health care information necessary for data entry, payment authorization, or quality initiatives. Perform data entry into the medical information system and other applicable data bases.
- Prepare correspondence and survey information for clinical staff; ensure adherence to regulatory, accreditation, and departmental standards.
- Research claims and coverage data and verify eligibility for payment purposes.
- Prepare monthly and ad hoc reports to support operational needs of the division and other duties as assigned to support corporate objectives.
- Assist team with department initiatives and projects.
- Perform other duties as assigned.
- High school degree
- Two to four years’ experience in a medical, hospital, or third party payer setting
- Knowledge of medical terminology
- Working knowledge of Microsoft Office including Excel, and Word
- General computer proficiency
- Written and verbal communications skills
- Good organization skills
- Time management skills
- Detail oriented
- Ability to research and organize data.
- Ability to organize work efficiently to meet established time and quality standards.
- Experience in claims
- Experience in a managed care environment
- Knowledge of state and federal health regulations and accreditation standards (e.g., NCQA, URAC, DOH, DHS, CMS)
- Proficiency with Microsoft Suite of products, i.e., Word, Excel, PPT, etc
BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role:
- In-office: onsite 5 days per week
- Hybrid: onsite 2-4 days per week
- Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia
The law requires an employer to post notices describing the Federal laws prohibiting job discrimination based on race, color, sex, national origin, religion, age, equal pay, disability, veteran status, sexual orientation, and genetic information and gender identity or expression. Please visit https://www.eeoc.gov/employers/eeo-law-poster to view the "EEO is the Law" poster.
