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Capital Blue Cross
Capital Blue Cross
1,001 – 5,000 Employees
H1B Visa SponsorConsultingHealthcareInsurance
Capital Blue Cross is a healthcare and insurance organization serving individuals, families, employers, and communities in Central Pennsylvania and the Lehigh Valley. Its offerings include health plans, Medicare coverage, student health plans, and resources designed to help members navigate medical care. The company focuses on accessible coverage, preventive health, and ongoing support for members’ broader wellness needs.
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Client Services Pharmacy Support Analyst – Pennsylvania Remote

Provide remote pharmacy support by researching benefits, claims, billing, and enrollment questions for Capital Blue Cross. Assist members, brokers, providers, vendors, and internal teams with accurate, timely resolutions.

USUnited StatesPAPennsylvania
$19 – $35 / hour
RemoteFull-timeMiddleSeniorEnglish RequiredSupport Engineer

Description

  • Research and assess customer inquiries related to vendor lines of business
  • Interpret applicable policies and procedures to determine the appropriate response
  • Retrieve benefits, enrollment, and claims information using computers, manuals, online references, Imaging, and other systems
  • Resolve routine and complex questions involving benefits, claims, billing, enrollment, legal requests, Medicare Secondary Payer, COBRA, reinstatements, conversions, refunds, and related matters
  • Deliver job-related instructional sessions when requested
  • Assist customers by phone, correspondence, on-site interaction, fax, Secure IT, email, and personal interview
  • Track vendor inquiries through system-generated reports to support timely and accurate resolution
  • Provide direction to the appropriate plan areas for issue resolution
  • Contact internal and external parties to gather information and initiate required action
  • Update Facets inquiries, Salesforce cases, and Work Desk records while maintaining progress notes
  • Escalate trends and processing issues to management
  • Assist Marketing staff and brokers by researching and communicating customer information
  • Support marketing activities, including open enrollment and on-site visits
  • Complete continuing training and develop new skills
  • Identify, document, and report customer-service trends to the supervisor
  • Demonstrate conduct aligned with organizational values

Requirements

  • At least three years of customer service or correspondence experience, or experience and training in a writing-intensive role
  • High school diploma or equivalent
  • Prior customer interaction experience preferred
  • Communicate effectively and professionally in verbal and written forms
  • Understand and interpret detailed policies and procedures
  • Understand HIPAA requirements for protecting Protected Health Information
  • Work independently and adapt to changing assignments and work environments
  • Apply analytical, organizational, and problem-solving skills
  • Operate a PC, related software, and office equipment proficiently
  • Use Windows, Outlook, Word, Internet Explorer, Excel, PowerPoint, SharePoint, and Salesforce competently
  • Demonstrate above-average reading, writing, and arithmetic skills
  • Understand Medicare Advantage, Medicare Part D, Medicare Supplemental Programs, Dental, Vision, Chiropractic, Prescription Drug, Benefits Management, and Disease Management
  • Understand PBM and Facets health plan administration processing systems
  • Understand benefits administration, billing, claims processing, ERISA, Act 68, BCBSA MTM, PPACA, HIPAA, and Account Administration regulations
  • Work 37.5 hours per week, including flexible schedules, nights, and weekends as business needs require

Benefits

  • Medical, dental, and vision coverage
  • Retirement plan
  • Paid time off
  • Paid holidays
  • Volunteer time off
  • Incentive plan
  • Tuition reimbursement
  • Flexible scheduling
  • Training and continuing education
  • Professional and personal growth opportunities
  • Community volunteering opportunities

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