New

Medical Management Administration Associate

Blue Cross and Blue Shield of Massachusetts, Inc.
vision insurance, paid time off, 401(k)
United States, Massachusetts, Hingham
Jul 31, 2025
Ready to help us transform healthcare? Bring your true colors to blue. The Role The Operational Support Specialist will provide multi-specialty support to Health and Medical Management clinical staff, including Care Management, Utilization Management, and the Physician Review Unit. The Operational Support Specialist has responsibilities that include inbound and outbound call support to members and providers, assisting management of clinical staff caseloads, performing various administrative tasks, and collaborating with teammates and leaders on missions for continuous process improvements. Our team values a team player with a positive mindset who works well with others, someone who displays flexibility, eagerness to learn new skillsets and excels practicing time management and organizational skills. This is a part-time position expected for 20hrs/week and is eligible for the eWorker persona. The Team The Clinical Operational Support Team is a team of non-clinical staff responsible for completing a variety of different tasks supporting clinical operations including the Physician Review Unit, Case Management and Utilization Management. Some of the tasks the operational support specialists (OSS) work include, fielding and triaging inbound calls from members interested in case management, reviewing and editing denial letters done by the Physician Review Unit, processing discharge dates for inpatient cases, building IVF cases and approving ABA cases. Key Responsibilities: Deliver reliable and timely non-clinical, administrative support services to Care Management, Utilization Management, and Physician Review Unit, tasks including but not limited to, staffing inbound phone line, working voicemail box, completing case assignments in Jiva, building cases in Jiva and MHK, processing discharge dates, requesting clinical and proofreading denial letters Identify and handle complex, priority and/or sensitive issues from external and internal members and staff within HIPAA regulations Assist in development, revision and maintenance of job aids and workflows Complete special and Adhok projects/tasks as determined by business needs Key Qualifications: Self- motivated proven ability to take ownership, master organization and time management Personal commitment to high quality through integrity, accountability, compassion and teamwork Strong interpersonal/relationship management skills Ability to carry out responsibilities with minimal direction to meet business needs in a high volume, fast paced and rapidly changing environment, in accordance with defined turnaround times Demonstrated flexibility, professionalism, and adaptability during change to meet business need Education and Experience: 1-4 years business experience in clinical or healthcare setting High School Diploma required, Associate's Degree or Bachelor's Degree preferred Call Center/ Triage experience preferred Knowledge of medical terminology preferred Strong computer systems knowledge including MHK, Jiva, RTMS, OLB and Microsoft Office Minimum Education Requirements: High school degree or equivalent required unless otherwise noted above LocationHingham Time TypePart time Hourly Range: $26.17 - $31.98 The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee's pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability. This job is also eligible for variable pay. We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees. Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. WHY Blue Cross Blue Shield of MA? We understand that theconfidence gapandimposter syndromecan prevent amazing candidates coming our way, so please don't hesitate to apply. We'd love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It's in our differences that we will remain relentless in our pursuit to transform healthcare for ALL. As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting ourCompany Culturepage. If this sounds like something you'd like to be a part of, we'd love to hear from you. You can also join ourTalent Communityto stay "in the know" on all things Blue. At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our "How We Work" Page.