Clinical In- Specialist

Role Overview

The Clinical Intake Specialist (Customer Service) is an integral part of Utilization Management processing telephonic and fax notifications, referrals, and requests for authorization from members, facilities, and physician offices. The Specialist facilitates efficient and timely requests by building and updating referrals and authorization requests in member records, working primarily by fax and telephone to ensure all necessary information is received for optimal review.

• Verify member eligibility and collect demographic and relevant clinical information.
• Build cases in the computerized member record using information gathered from faxes and/or phone calls.
• Document information using department standards of documentation.
• Communicate with providers regarding the assigned DRG or necessary decision data.
• Assign accurate codes to all diagnoses and procedures and update cases when applicable.
• Coordinate with the Clinical Review team to ensure continuity of the notification, coding, and review processes.
• Manage workload within regulatory turnaround time requirements and mandated time frames for processing cases.
• Handle protected health information consistently with department and company policies and regulatory requirements.
• Assist in refinement and implementation of unit workflows and new utilization management processes to enhance efficiency and support unit/department goals.
• Engage in cross‑training to support all team responsibilities.
• Perform other duties as assigned.

• High school diploma or GED required; associate’s degree preferred.
• Excellent attendance, punctuality, and professionalism.
• Comfortable working in a high-volume, fast-paced call center environment.
• Strong attention to detail and ability to meet deadlines.
• Customer service training or previous call center experience highly desired.
• Knowledge in DRG assignment, human anatomy/physiology/clinical disease processes, or medical terminology strongly preferred.
• Strong communication, telephone, and writing skills.
• Previous experience in a medical/clinical setting preferred.
• Proficiency in Microsoft Office and computer programs; tech savvy.

• Hourly rate: $21.54.
• Salary range:
  The posted range represents the lowest to highest salary we believe we would pay for this role at the time of posting. Pay may be modified as needed.
• Variable pay eligibility.
• Benefits include 100% eligibility on BCBSMA's Benefit & Wellness Plans, paid time off, medical/dental/vision insurance, 401(k), and well-being benefits.
• Full support and engagement from a dedicated, dynamic team.
• Professional development and career opportunities after 12 months of service.
• Daytime work hours:
  Monday-Friday 8:30 AM-4:30 PM.
• 90‑day training program required.

High school diploma or equivalent required unless otherwise noted above.

Blue Cross Blue Shield of Massachusetts is an Equal Employment Employer - veterans/disability. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or expression, or any other characteristics protected by law. Blue Cross Blue Shield of Massachusetts will not discharge or discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant.

Employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with Blue Cross Blue Shield of Massachusetts's legal duty to furnish information.