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Anthem, Inc. Clinical Support Specialist II - Fully remote position!! in Dearborn, Michigan


SHIFT: Day Job

SCHEDULE: Full-time

Job Title: Clinical Support Specialist II Exemption Status: Non-Exempt Reports to: Clinical Support Manager, Clinical Support Supervisor Job Code: ST5934 Salary Grade: Union – Grade 5b

**This position works 37.5 hrs a week. The hours are: M-F, 1130a - 8 pm (EST)

Your Talent. Our Vision. At Anthem, Inc., it's a powerful combination, and the foundation upon which we're creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.

Due to the current COVID-19 (coronavirus) pandemic, this position will require you to work remotely from your home with the expectation that you will return to a regular, in-office work environment. As we continue to monitor guidance from CDC and state officials there may be times you would need to report to the office on a monthly or quarterly basis for team meetings or engagement activities.

For patient/member-facing roles with direct patient/member clinical setting interaction (clinic, member home, care facility) and PulsePoint essentials (roles that cannot be performed virtually), recruiters should ensure the job posting includes the statement:

The health and safety of our associates, members and communities is a top priority for Anthem. This priority has become increasingly important as we continue to face the challenges of the COVID-19 pandemic. Anthem believes vaccination is the best way to reduce the spread of COVID-19 and protect our members, our communities, our families and ourselves. To minimize the risk of transmission of the COVID-19 virus and maintain a safe and healthy workplace, vaccination is required for this role. (At Anthem, fully vaccinated means it has been at least two weeks since you have received the second dose of a two-dose vaccine such as Moderna or Pfizer, or the single dose of a single dose vaccine, such as Johnson & Johnson).

If you do not meet the requirements for this position, we encourage you to review other positions that currently allow virtual work. If you have a medical or sincerely held religious reason for not being vaccinated, consistent with applicable law, Anthem will consider requests for reasonable accommodation on this basis. Should you have any questions regarding the requirement after applying, email

General Summary

The Clinical Support Specialist II is the front-line interface to members and providers who seek information about behavioral health benefits. Assist callers by providing benefit and eligibility information and referrals to network providers. Assist with Clinical Department operations Conduct referrals, follow-up protocols, investigation of complex member/provider issues not requiring a medical necessity determination, claims issues and managing data to ensure patient and provider continuity of services. Provide guidance and handle complicated inquiries related to case initiation to internal and external customers. Educate providers/subscribers in the certification process and help to reconcile inconsistencies and procedural difficulties.

Duties and Responsibilities 1. Interface with medical carriers, claims payers, other. Initiates and maintains positive and productive relationships with external and internal customers. Handles difficult customer service problems and expedites resolution.

  1. Assist department/unit with call management. Interface with external and internal customers to ensure optimal efficiency of accessing behavioral health services. Provide education to providers and members on all aspects of care management services. Perform review of service request for completeness of information.

(Kaiser Unit Only): Verifies member benefits and eligibility through health plan computer access, phone, and e-mail. Educates callers about Beacon/BCBHM services and their mental health benefits. Obtains urgent, routine with assistance appointments within established time frame guidelines. Checks voice mail and return calls within 1 business day. Checks e-mail to stay informed of procedures and communicate with team members. Works with health plan, County entities, community agencies and providers to effectively coordinates member care.

  1. Verify benefits against contract requirements prior to case initiation. Refer complicated inquires to Care Managers. Complete transactions/authorizations. Prepare account specific cases for Care Manager follow-up. Process account specific outpatient authorizations. Assist with triage assessment and referral process.

  2. Search for specialty providers or referrals in areas with difficult access and may respond to complicated inquiries. May participate in the investigation and resolution of claims and/or case issues. Oversee and support work process for clerical support staff. Collect and transfer non-clinical data. Acquire structured clinical data. Perform activities that do not require evaluation or interpretation of clinical data. Obtain and enter discharge information. Participate in periodic systems testing. 5. Perform responsibilities in accordance with contract standards. Provide training, as needed based on department needs. Assist service center with compliance of regulatory standards.

  3. Initiate and maintain all databases and records used by the Department. Enter data, update and/or correct information, run queries and reports. Prepare symposium reports.

  4. Perform administrative and clerical duties as needed, to support the business and service needs of the Department. Create and generate documents, reports, tables and graphs from raw data. Enter and update information, run reports and interpret data from the system as necessary.

  5. Apply Beacon Health Options policies and procedures consistently. Maintain confidentiality of Clients, Business Records and Reports. Maintain ethical and professional standards. Maintain individual productivity and performance standards. Meet Departmental expectations; accuracy, productivity and performance standards. Support Beacon Health Options in achieving Mission Statement. Adhere to the components of the Compliance Program. Ensure that job tasks are performed in a legal and ethical manner. Actively assess work area for non-compliance issues and notify supervisor or call Ethics Hotline. Adhere to compliance training requirements and understand that training is required condition of employment. Complete tasks accurately and within required timeframes.



  • Requires a Bachelor’s degree.

  • Minimum of two years’ experience supporting clinical staff in a Community Mental Health setting or 5 years in a Behavioral Health clinical service support environment.

Preferred Qualifications: Experience using management information systems, word processing, and spreadsheet applications including knowledge of Microsoft office. Excellent time management, organizational skills and telephone service skills required. Must demonstrate ability to maintain a professional demeanor during crisis situations. Must possess an excellent work ethic, team attitude and be able to function in a multi-disciplinary team environment. Communication and MIS skills will be demonstrated during the interview process. Employee Compliance Requirements

All employees must comply with the following:

• Comply with all HIPAA Compliance regulations. • Adhere to the components of the Compliance Program and annual training requirements. • Understand that annual training is a required condition of employment. • Ensure job tasks are performed in a legal and ethical manner. • Actively assess work area for non-compliance issues and notify supervisor or call the Ethics Hotline. • Participate in corporate and local quality and utilization management programs as appropriate.

The Americans with Disabilities Act (ADA) “prohibits discrimination against qualified individuals with disabilities”. As defined by the ADA, a qualified individual with a disability is 1) an individual with a disability who satisfies the requisite skill, experience, education and other job-related requirements of the position an individual holds or desires; and 2) an individual who, with or without reasonable accommodation, can perform the essential functions of such position.

Carefully consider the information provided about this job in this document as you read through the ADA Checklist on the following pages, and provide the best answer and information. Keep the following in mind:

a. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily, either with or without reasonable accommodations. Consider what duties truly are essential and the types of accommodations that are possible. b. The minimum qualifications listed must be representative of the knowledge, skills, minimum education, training, licensure, previous work experience and/or abilities required in order to perform the essential duties satisfactorily. c. Consider the work environment and things like the noise level, as in a call center, or if someone in facilities needs to use ladders to change light bulbs or fix certain things. d. Consider whether duties are primarily performed in an office space and if they restrict movement in any way, like a customer service representative or care manager/EAP telephonic clinician using a headset and computer screen for extended periods of time and on scheduled breaks, or a PC/Desktop support specialist transporting and installing hardware and going under desks to access electrical outlets.   We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.