Managed Care Coordinator II, Bilingual – Spanish Speaking

NJM Insurance Group

Managed Care Coordinator at Horizon Blue Cross Blue Shield supporting clinical operations and serving as a liaison. Handling member inquiries, coordinating services, and assisting in case management.

Posted 4/24/2026full-timeRemote • New Jersey • 🇺🇸 United StatesMid-LevelSenior💰 $50,100 - $67,095 per yearWebsite

About the role

Key responsibilities & impact

Supports the Clinical Operations functions and acts as a liaison between members, physicians, and service coordinators.
Performs review of service requests for completeness and collects non-clinical data.
Initiates call backs/correspondence to coordinate and verify benefits/treatment.
Assists members with finding providers and resolving problems regarding services.
Makes outbound calls to engage members in Case Management.
Reviews medical, dental, and vision claims.

Requirements

What you’ll need

High School Diploma/GED required
Prefer 3-5 years customer service experience
Requires knowledge of medical terminology
Requires Good Oral and Written Communication skills
Requires ability to make sound decisions under the direction of Supervisor
Prefer knowledge of contracts, enrollment, billing & claims coding/processing
Prefer knowledge Managed Care principles

Benefits

Comp & perks

Comprehensive health benefits (Medical/Dental/Vision)
Retirement Plans
Generous PTO
Incentive Plans
Wellness Programs
Paid Volunteer Time Off
Tuition Reimbursement

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

medical terminologybillingclaims codingclaims processingcontracts knowledgeenrollment knowledgecustomer service

Soft Skills

oral communicationwritten communicationdecision makingproblem solving

Certifications

High School DiplomaGED