BlueCard Multi Service Specialist I or II, DOE
Cambia Health Solutions

Salem, Oregon

This job has expired.


Primary Job Purpose

The position is open to candidates who are located within Oregon, Washington, Idaho and Utah.

The Blue Card Multi Service Specialist I, II provides information, education and assistance to internal and external customers, by entry, activation or billing of individual subscribers and group accounts, according to benefits contract.

General Functions and Outcomes

  • Communicate with a variety of providers, group administrators, other member representatives and internal staff for questions pertaining to claim payments and denials, decisions, and other information through a variety of media - oral, written and on-line communications. Respond to multiple inquiries on all designated lines of business.
  • Quickly and accurately assess provider inquiries and requirements by establishing a rapport with the other person in order to understand his/her service needs.
  • Identify errors promptly and determine what corrective steps may be taken to resolve errors.
  • Make appropriate corrections of denied, process-in-error or re-classified claims.
  • Document inquiries and actions on-line and/or by completing logs.
  • Explain complex benefits, rules of eligibility and claims payment procedures, preauthorizations, medical review and referrals, and grievance/appeal procedures to providers to ensure that benefits, policies and procedures are understood.
  • Educate providers on confusing terminology and policies such as eligible medical expenses, hold harmless, medical necessity, contract exclusions and limitations, and managed care products.
  • Determine benefit payments, maximum allowable fees, co-pays, and deductibles from appropriate contracts.
  • Maintain confidentiality and sensitivity in all aspects of internal and external contacts.
  • Manage high-volume of calls on a daily basis and prioritize follow-through, and provide timely response and follow up on outstanding issues. May generate written correspondence and process document requests.
  • Accurately apply contract benefits within guidelines and recognize incomplete or inappropriate claims. Make decisions regarding the disposition of claim; may include payment/denial of claim or request for further medical review, provider fee audit, medical record(s) and/or accident reports.
  • Apply knowledge of medical terminology, ICD-9, CPT coding and other resources to resolve claim issues.
  • Adapt to changes that affect the job, including contract changes as well as procedure or system changes in order to ensure correct processing of claims.
  • Process claims that are not eligible for auto processing.
  • Handle General Inquiries, appeals, adjustments generated by calls or correspondence and new bills.
  • Keep all documents, policies, procedures and guidelines updated and readily accessible.
  • Maintain confidentiality in all aspects of processing and appeals.
  • Comply with MTM and Consortium standards as they relate to the employee's responsibility to meet BlueCross BlueShield Association (BCBSA) standards and corporate goals.
  • Work overtime and on weekends as needed.
  • Complete special projects or reports as requested by management.
  • Other assigned projects or duties as assigned by management.
Minimum Requirements
  • At least one year experience in Claims, or Membership and Call Center/Contact Center Customer Service required.
  • PC experience and familiarity with corporate software, such as MS Word and Excel, or comparable software, if required.
  • Excellent communication skills and the ability to communicate clearly and concisely, verbally and in writing.
  • Ability to work independently with a minimum supervision.
  • Ability to listen and communicate appropriately with provider community, member representatives, and coworkers in a manner that promotes positive, professional interaction while maintaining member/provider confidentiality.
  • Ability to make decisions and exercise sound judgment.
  • Ability to organize and prioritize workload and to meet deadlines.
Work Environment
  • Ability to physically perform essential job duties.
  • May sit and key at PC for extended periods of time.
This position includes 401(k), healthcare, paid time off, paid holidays, and more. For more information, please visit www.cambiahealth.com/careers/total-rewards.

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A drug screen and background check are required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.


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