Note: The job is a remote job and is open to candidates in USA. Blue Cross NC is a health insurance organization focused on delivering healthcare services and supporting the communities it serves. The Operations Specialist will provide operational and healthcare support for members and providers by conducting outreach, addressing quality and risk adjustment care gaps, guiding members toward appropriate care and benefits, and maintaining related documentation, reports, and processes.
Responsibilities
- Perform at the expected level of service to enhance customer interaction and experience
- Provide regular communication to leadership and other team members on the results of member and/or provider engagements including the potential to participate in regular meetings with key stakeholders and members of upper management
- Perform outreach based on assignments received through various methods, including outbound calls to various providers, members, vendors, or other outside contacts to increase health behavior participation and drive positive health outcomes for our members
- Make direct calls to members using effective engagement strategies to respectfully encourage members to utilize available benefits in support of member health behavior participation
- Maintain member confidentiality per HIPAA compliance guidelines
- Coach, educate and guide members in health program participation and preventive care tactics
- May support other team members through referrals, mailbox management, work assignment and relevant documentation
- Service as the subject matter expert around work process, procedures, products, and policies and provide support, first level escalation, and research support as needed
- May assist in the review and updating of existing and creation of new processes & procedures
- Provide cross functional support and departmental expertise to varied internal stakeholders
- Responsible for maintaining reports, tracking and/or data analysis as assigned or as needed
- Performs other tasks as assigned by leadership
Skills
- * High school diploma or GED
- * 3+ years of experience in related field
- * Experience working with operational healthcare systems is highly preferred
- * Facets – Experience navigating member records, eligibility, benefits, and healthcare-related information
- * Genesys – Proficiency in call management, queue monitoring, outbound and inbound call activities, wrap-up documentation, and performance metrics
- * Salesforce – Experience documenting member interactions, managing cases, tracking outreach activities, and maintaining accurate records
- * Blue Connect – Ability to navigate member-facing healthcare tools and resources to support member inquiries and engagement activities
- * Microsoft Excel – Strong working knowledge of Excel, including data entry, filtering, sorting, reporting, spreadsheets, and basic data analysis
Benefits
- Work-life balance, flexibility, and the autonomy to do great work
- Medical, dental, and vision coverage along with numerous health and wellness programs
- Parental leave and support plus adoption and surrogacy assistance
- Career development programs and tuition reimbursement for continued education
- 401k match including an annual company contribution
- Annual Incentive Bonus
- Paid Time Off (PTO)
- Competitive health benefits and wellness programs
- Hybrid Flex or Remote Flex work arrangements, depending on the nature of the work and distance from the Durham headquarters
- In a Hybrid-Flex role, you’ll work in the office at least two days a week for collaboration and connection
- In a Remote Flex role, you’ll work virtually, with a few in-office visits each year for meaningful moments that matter
Company Overview
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