Advanced Claims Examiner & Adjudication Specialist

Excellus BCBS; United States; Remote; USD 28,000 - 46,000; Full time

Benefits offered by this job

Remote work option

Job summary

Excellus BCBS is seeking a Claims Examiner to resolve a broad range of claims transactions, including entry, adjudication, and adjustments, in line with MTM, NCQA and policy requirements. The role emphasizes accurate processing and protecting member privacy.

Level progression adds complexity: handling complex claims, identifying trends, mentoring peers, and advancing processes. A High School diploma and NYS Independent Adjuster license are noted; remote work may be available.

Qualifications

• High School diploma or equivalent required.
• Relevant customer service or claims processing experience preferred.
• Capacity to continuously develop skills necessary for growth.
• Basic computer required, including the ability to navigate in a Windows environment.
• Adept at multi-tasking to efficiently resolve moderately complex claims processing and simple adjustment transactions.
• B Version: Valid NYS Independent Adjuster License and continued administrative maintenance of renewals is required.

Responsibilities

• Handle front end transactions including eligibility, entry of claims, member & provider matching and claim processing.
• Process, enter, adjudicate and/or adjust and research claims.
• Identify patterns that impact quality, claim inventory, and customer experience and escalate as needed.
• Work closely with other required internal departments.
• Consistently demonstrate professionalism, integrity and attention to privacy.

Skills

Customer service

Claims processing

Attention to detail

Self-management

Multi-tasking

Education

High School diploma or equivalent

Job description

Excellus BCBS is seeking a Claims Examiner to resolve a broad range of claims transactions, including entry, adjudication, and adjustments, in line with MTM, NCQA and policy requirements. The role emphasizes accurate processing and protecting member privacy.

Level progression adds complexity: handling complex claims, identifying trends, mentoring peers, and advancing processes. A High School diploma and NYS Independent Adjuster license are noted; remote work may be available.