Clinical Support Specialist

Capital Blue Cross

Clinical Support Specialist providing administrative support to assigned clinical teams at Capital Blue Cross. Involved in medical management processes and community events coordination.

Posted 6/11/2026full-timeRemote • Pennsylvania • 🇺🇸 United StatesJuniorMid-Level💰 $19 - $35 per yearWebsite

About the role

Key responsibilities & impact

Provides administrative support to assigned clinical team, as directed by the Team Lead and/or Manager
Assist 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

Requirements

What you’ll need

Minimum 2 years’ experience in the medical field (e.g. medical assistant, medical secretary) or 2 years’ experience in a managed care clinical department
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)

Benefits

Comp & perks

Medical, Dental & Vision coverage
Retirement Plan
Generous time off including Paid Time Off
Holidays
Volunteer time off
Incentive Plan
Tuition Reimbursement
Comprehensive benefits packaging

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

medical record documentationcase authorizationreport monitoringmedical terminologyhealth plan benefitsPPOPOSHMOFEPNCQA

Soft Skills

organizational skillstime managementattention to detailwritten communicationoral communicationprofessionalismcollaborationproblem-solvingcustomer servicepersonal growth