Precertification Specialist

Anticipated work hours are between 8:00a.m. - 6p.m. (overtime is not mandatory, but will be asked as needed; weekends are expected on a rotation on Saturdays)

Required Skills and Experience:

Medical Terminology or medical background such as nursing assistant/tech or doctor office experience

Customer Service experience

Exceptional phone skills

Administrative/PC skills

Education/Certifications – Include:

Associate degree level preferred

Highly preferred:

  • Provide high quality, member focused servicing using knowledge of plans, products, systems, and procedures to meet or exceed member experience
  • Assist in locating primary care physicians, specialists and dentists
  • Thoroughly explain wellness care management program benefits to members
  • Work as a team member to assist nurses in researching providers, eldercare, nursing homes
  • Concisely and accurately enter documentation into Care Advance
  • Effectively engage over the phone via both inbound and outbound members that qualify for our clinical programs or those who are interested in learning more about our services
  • Refer and/or warm transfer to wellness and care management components and other BCBSM areas and vendors as needed
  • Process provider requests as needed
  • Act as member's first trusted source for WCM programs
  • Schedule appointments between the member and coach in appropriate systems
  • Assign referrals to designated staff
  • Process requests for compliance inquiries
  • Access various WCM department mailboxes and voicemail as needed

Ability to function independently

Critical Thinking

Quick learner

Bi-Lingual/Spanish

Category Clerical

Function Clerical / Administrative

Req ID JN -062024-121233