Independence Blue Cross · 5 hours ago
Pre-Certification Specialist - Remote (PA/NJ/DE)
United States
Full-time
Remote
Mid Level
3+ years expIndependence Blue Cross is seeking a Pre-Certification Specialist to help renew and reimagine the future of health care. The role involves processing precertification requests and ensuring compliance with corporate guidelines and regulations while providing excellent customer service in a high-volume call center environment.
Health CareHealth InsuranceInsuranceMedical
Responsibilities
Answers incoming telephone calls in a high-volume Call Center environment from members and health care professionals regarding requests for precertification of health services
Verifies member eligibility by accessing multiple eligibility systems
Verifies participation status of professional and facility providers, by product and state utilizing multiple database systems including the National Provider Identification(NPI) Registry
Processes precertification requests from members and providers received telephonically, via fax or NaviNet per department guidelines
Obtains all clinical information including procedure and diagnosis codes
Enters all pertinent data in the appropriate computer system
Approves selected services per departmental guidelines
Identifies precertification requests that warrant a medical necessity review
Identifies potentially cosmetic and investigative/experimental procedures
Adheres to the departmental standards for staff time, after call work, attendance and non-queue production
Adheres to the corporate quality customer-focused professionalism and accuracy standards
Responds to voicemails and emails within one business day, as necessary
Performs additional duties as assigned
Qualification
Required
High school diploma required
A minimum of three years of customer service experience in the health insurance industry or health services industry strongly recommended including knowledge of medical terminology, a general understanding of managed care delivery systems and a familiarity with ICD9/ICD10 and CPT codes
Excellent organizational, interpersonal, verbal and written communication skills, necessary
Detailed oriented with an ability to accept and respond to changes
Experience accessing, navigating, and data entering into computerized databases required. Specifically, Word, Excel, and Mainframe
Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app
Preferred
Associate degree in a related field preferred
Knowledge of INSINQ is a plus
Company
Independence Blue Cross
The leading health insurer in southeastern Pennsylvania. It is a sub-organization of Independence Blue Cross.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Alexandra Jorgensen
Senior Vice President Human Resources
Joe Geist
SVP & Market President, National
Recent News
Home Health Care News
2026-01-14
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