Job Details

Job Summary: Join our team as a dedicated Intake Specialist to manage all inbound inquiries related to utilization management from healthcare providers and pharmacies. In this essential role, you will evaluate requests, verify member benefit coverage, and create cases in Highmark's Utilization Management system for clinical review. Your keen attention to detail is vital for ensuring compliance with regulatory standards and service agreements. Communication may occur through various methods including fax, provider portal, or inquiry forms, requiring occasional follow-up with healthcare providers.

Essential Responsibilities:

• Receive and process provider or pharmacy requests via fax, provider portal, and occasionally phone. Effectively utilize multiple software systems to confirm member eligibility and gather necessary documentation.
• Evaluate cases that require additional notifications to members or providers, and if needed, reach out for further information.
• Maintain accuracy in data entry to avoid compliance issues and advance downstream processes.
• Carry out additional tasks as assigned.

Experience:

• A minimum of 1 year of Customer Service experience.
• A minimum of 1 year of experience in the Healthcare Industry.

Skills:

• Excellent written and verbal communication abilities.
• Proficiency in navigating multiple systems at once.
• Familiarity with administrative tasks, including word processing and file management.
• Strong interpersonal skills for effective engagement with colleagues and clients.
• Good problem-solving abilities.
• Understanding of customer service principles and standards.

Education:

• High School diploma or GED is required.

Licenses or Certifications:

• No specific licenses or certifications are required.

Travel Requirement: Limited travel required (0% - 25%).

Environment and Working Conditions:

• This position can be office-based or remote.
• May occasionally involve training others.
• Some rare travel from the office to various work sites may be necessary.
• No physical labor related to site sales tasks required.
• Constantly lifting up to 10 pounds, occasional lifting of 10 to 25 pounds, and rare lifting of 25 to 50 pounds.

Pay Range: Starting at $19.27, with potential to increase up to $26.88 per hour, based on qualifications and experience.

At Highmark Health, we are dedicated to providing equal employment opportunities for all individuals, regardless of protected statuses. We also strive to offer an accessible application process for all candidates.