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Description
We are offering a long-term contract employment opportunity for an Intake Specialist located in Durham, North Carolina. As an integral part of our team, you will be responsible for supporting the Carelon Initiative and Concurrent Review, as well as providing preliminary analysis for the Appeal process. Working remotely or on-site, based on your preference, you will be handling a variety of requests, inquiries, and transactions in the healthcare claims industry.
Responsibilities
• Processing a variety of requests, inquiries, and transactions through various communication channels including phone, email, fax, and mail.
• Conducting thorough reviews of requests to ensure accuracy and compliance.
• Providing support to both internal and external customers through phone or email correspondence.
• Documenting all pertinent information related to calls or inquiries and attaching supporting information when necessary.
• Gathering and analyzing data to provide feedback to team leads on employee development needs and/or specific providers requiring education on prior approval or pre-certification processes.
• Screening inquiries to determine if authorization is required for specific processes.
• Verifying member benefits and eligibility as well as provider setup to ensure accurate records.
• Maintaining and updating Service Requests while researching incorrect or missing information.
• Efficiently triaging and assigning all incoming inquiries to appropriate staff throughout the day.
• Conducting monthly Peer Audits as required to ensure compliance and maintain standards.
• Providing clinical review outcome notification to members and providers both verbally and in written form.
Requirements
• Possess strong training skills with the ability to impart knowledge to team members effectively.
• Demonstrated expertise in planning and executing various planning processes.
• Proven experience in conducting thorough research on various subjects related to the job role.
• Ability to review and analyze various documents, reports, and data with a keen eye for detail.
• Knowledge of insurance policies and procedures is essential.
• Proficiency in using various workstation support tools and software.
• Experience in auditing processes, ensuring compliance with relevant laws and regulations.
• Exceptional phone presence with excellent communication and interpersonal skills.
• Understanding of benefit functions and the ability to implement them effectively.
• Familiarity with hiring processes including screening, interviewing, and onboarding.
• Ability to handle financial notes, data analysis, and authorizations.
• Experience in dealing with missing invoices and appeals, ensuring accuracy in all transactions.
• Ability to liaise with appropriate personnel within and outside the organization.
• Experience in serving external customers, providing excellent customer service.
• Knowledge of fax machines and other office equipment.
• Ability to effectively triage tasks and prioritize work.
• Experience in Service Request Management, ensuring all requests are handled efficiently.
• Familiarity with HealthCare Claim processes and procedures.
• Excellent data analysis skills with the ability to interpret complex data sets.
• Experience in ensuring accuracy in all tasks and processes.
• Fluency in English language, both written and spoken, is essential.
• Ability to work effectively in a team as well as independently.
• Strong problem-solving skills and the ability to make decisions under pressure.
• Excellent organizational and time management skills.
• Proficiency in Microsoft Office Suite including Word, Excel, and PowerPoint.
Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.
Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity – whenever you choose – even on the go.
All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit
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