Capital Blue Cross · 4 hours ago
Clinical Support Specialist
Harrisburg, PA
Full-time
Onsite
Entry Level
2+ years expCapital Blue Cross is a company that prioritizes the health and well-being of its employees and community. The Clinical Support Specialist provides administrative support to the clinical team, assisting with medical record documentation and communication with members and providers.
ConsultingHealth CareHealth InsuranceProfessional Services
Responsibilities
Assists with medical record documentation requests and leverages medical management system to initiate case and/or authorization to support clinical processes (e.g. UM, CM)
Conducts fax and telephonic outreach; and written communications to members and/or providers to communicate status of UM/CM processes (e.g. verbal notification, engagement status, discharge plan)
Supports administrative functions with community events (e.g. health fairs)
Accurately documents all interventions in the member’s medical management record in accordance with established policies and procedures
Actively participates in supporting department compliance and performance through administrative activities such as report monitoring/distribution, and other tasks as assigned by leadership
Adheres to all regulatory and compliance standards, including adherence to all Capital and department specific policies and procedures
Interacts courteously and professionally with customers, including internal staff, vendor partners, providers, and members to support collaborative medical management functions
Identifies and reports potential quality of service/care issues as established and within the guidelines of intradepartmental processes
Promotes personal growth through participation in staff meetings, appropriate in-services, and corporate training
Identifies opportunities and proposes alternatives for improving the Population Management functions
Qualification
Required
Minimum 2 years' experience in the medical field (e.g. medical assistant, medical secretary) or 2 years' experience in a managed care clinical department
High School Diploma required
Strong organizational and time management skills
Demonstrated strong attention to detail and accuracy
Ability to follow job responsibilities as outlined in departmental policies and procedures
Excellent written and oral communication skills
Working knowledge and operation of a personal computer, including proficiency in Microsoft Office applications
Working knowledge of medical terminology
Working knowledge of the health insurance industry, health plan benefits and product lines (e.g., PPO, POS, HMO, FEP, Senior Products, Traditional/Comprehensive)
Knowledge of regulatory and accreditation standards and requirements (e.g. NCQA, CMS)
Preferred
Continued higher education preferred
Benefits
Medical, Dental & Vision coverage
Retirement Plan
Generous time off including Paid Time Off
Holidays
Volunteer time off
Incentive Plan
Tuition Reimbursement
Company
Capital Blue Cross
At Capital Blue Cross, we promise to go the extra mile for our team and our community.
1001-5000 employees
H1B Sponsorship
Capital Blue Cross has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (4)
2024 (13)
2023 (5)
2022 (9)
2021 (5)
2020 (5)
Funding
Current Stage
Late StageLeadership Team
Glenn Heisey
Executive Vice President and Chief Operating Office
Recent News
2025-10-02
2022-10-14
Company data provided by crunchbase