Provide administrative and analytic support for the Health Services Department. Handle initial steps of pre-authorizations, referrals, case management, and/or claims reviews. Gather data from hospitals, providers, and members. Research eligibility, benefits, and planned medical interventions. Obtain clinical information and other data needed to make determinations. Enter appropriate information into system. Assist professional staff with medical management processes.
Work Experience: 1+ year of experience in the health insurance industry or a medical background required.
Education, Certificates, Licenses: High school diploma or equivalent required.
Knowledge: Charged with being consistently helpful, confident, professional, and pleasant when working with a wide variety of personalities while supporting PacificSource's decisions. Responsible for documentation of information given and received. Knowledge of and skill in the use of personal computers and MSWord required. General clerical, written and oral communications skills, medical terminology required. Ability to analyze and provide timely and accurate responses.
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately less than 5% of the time.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.