Pre-Certification Specialist - Remote (PA/NJ/DE)

Role Overview

Independence Blue Cross is seeking a motivated, service-minded professional to support precertification processing. In this role, you will work under the guidance of a manager and licensed health professionals to review precertification requests in line with company policies and all applicable state and federal rules. The position is fully remote, but the work must be performed from the Tri-State area of Delaware, New Jersey, or Pennsylvania.

The organization is focused on growth, innovation, service, and creating a more diverse and forward-thinking workplace. Candidates who are collaborative, customer-focused, and eager to learn are encouraged to consider this opportunity.

Key Duties

• Handle a high volume of incoming calls from members and health care professionals regarding precertification requests.
• Confirm member coverage by using multiple eligibility platforms.
• Check provider participation status by product and state through several database systems, including the National Provider Identification Registry.
• Review and process precertification requests received by phone, fax, or NaviNet according to department procedures.
• Collect all required clinical details, including procedure and diagnosis codes.
• Record relevant information accurately in the appropriate systems.
• Authorize selected services when they meet department criteria.
• Flag requests that require review for medical necessity.
• Identify procedures that may be considered cosmetic or investigative/experimental.
• Meet departmental expectations for time management, after-call work, attendance, and non-queue productivity.
• Maintain the organization’s standards for quality, customer service, professionalism, and accuracy.
• Return voicemails and emails within one business day when needed.
• Carry out other assigned tasks as required.

Experience and Education

A high school diploma is required. An associate degree in a related area is preferred.

Applicants should have at least three years of customer service experience in the health insurance or health services field. Useful background includes knowledge of medical terminology, a general understanding of managed care delivery systems, and familiarity with ICD-9, ICD-10, and CPT coding.

The role also requires strong organization, interpersonal skills, and clear verbal and written communication. Candidates must be detail-oriented and comfortable adapting to change.

Experience using computerized databases for searching, navigation, and data entry is required, including proficiency with Word, Excel, and mainframe systems. Familiarity with INSINQ is considered an advantage.

Work Arrangement and Technical Requirements

This is a fully remote position. The selected candidate will not need to report to a physical office, but must be able to work from Delaware, New Jersey, or Pennsylvania.

Applicants must have an Android or iOS device that can support the free Microsoft Authenticator app.

Equal Opportunity Statement

Independence Blue Cross is an equal opportunity employer and considers all qualified applicants without regard to age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.