Claim Technician

Health Care Service Corp.; Albuquerque (NM); Hybrid; USD 24,000 - 36,000; Full time

Job summary

Health Care Service Corp. is seeking a Claims Technician to process complex medical claims, investigate discrepancies, and adjudicate claims accurately under HIPAA guidance. The role emphasizes attention to detail, data integrity, and collaboration with internal departments and providers.

The position includes six weeks of onsite training, with afterward potential work-from-home provisions. Candidates should have a high school diploma, data entry proficiency, and experience handling high-volume

Qualifications

• High School diploma or GED required.
• Solid data entry and/or typing experience.
• Proficiency in Microsoft Office Suite, including Excel for data review and reporting.
• Clear written and verbal communication skills.
• Experience processing medical claims with ability to manage high-volume workloads.

Responsibilities

• Process complex claims in various queues.
• Research missing information and contact providers to adjudicate timely.
• Resolve complex pended and duplicate claims and adjustments.
• Process claims and communicate with participating plans/Service Units.
• Update patient files and coordinate benefits as needed.
• Maintain knowledge of medical terminology and CPT/HCPCS/ICD9 coding.

Skills

Data entry

Typing

Communication

Attention to detail

Claims processing

Education

High School diploma or GED

Tools

Blue Chip

Microsoft Excel

Job description

Job Summary

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development.

BASIC FUNCTION Under supervision, this position is responsible for processing complex claims requiring further investigation, including coordination of benefits and resolving pended claims. The Claim Technician is responsible for reviewing, processing, and adjudicating healthcare claims accurately and efficiently in accordance with company policies, payer guidelines, and regulatory requirements. This role investigates claim discrepancies, researches denials, verifies member and provider information, and ensures timely claim resolution. The Claims Technician also collaborates with internal departments, providers, and members to resolve claim issues while maintaining high standards of accuracy, productivity, compliance, and customer service. The ideal candidate demonstrates strong analytical skills, attention to detail, and knowledge of healthcare claims processing, medical terminology, and applicable regulations, including HIPAA. Starting pay falls between: $17.75 to $18.25, commensurate with experience NOTE: there is a mandatory six-week onsite training with strict attendance requirements which occurs Monday-Friday (8am to 5pm). Upon successful completion of this training, work from home provisions will be established.

JOB REQUIREMENTS

• High School diploma or GED.
• Solid data entry and/or typing experience.
• Proficiency in Microsoft Office Suite, including Excel for data review and reporting.
• Clear and concise written and verbal communication skills.
• Experience processing medical claims with the ability to manage high-volume workloads while maintaining quality metrics.
• Strong attention to detail, problem-solving, and organizational skills.

PREFERRED REQUIREMENTS

• Must have trained on the six or eight-week Blue Chip claims processing system or have the ability to fully complete the six or eight-week Blue Chip Training class.
• Knowledge of medical terminology and CPT, HCPCS, and ICD9 coding.
• Knowledge of coordination of benefits principles and terminology.
• Familiarity with claims adjudication systems and healthcare payer processes.
• Experience with multi-tasking and prioritizing.

KEY FUNCTIONS

• Process complex claims in various queues.
• Conduct research and investigation into missing information, make phone calls to providers (as necessary), access resource materials and support files in order to process and adjudicate claims timely and accurately.
• Resolve complex pended claims, duplicate claims and adjustments.
• Process claims, involving communications with participating plans and/or Service Units.
• Resolve various issues.
• Research and identify other insurance, Medicare, Medicaid and update patient file as needed.
• Coordinate benefits; request explanation of benefits as needed.
• Maintain a working understanding of medical terminology and CPT, HCPCS, and ICD9 coding.
• Maintain knowledge related to specific contracts.
• Read appropriate files in IMAGE and apply information to claims as needed using the Financial Suspense System (FSS).
• Learn and maintain knowledge of DOL ERISA and prompt pay legislation.
• Periodic overtime may be required at the sole discretion of the employer based on business need.

PAY TRANSPARENCY STATEMENT

• Health and wellness benefits
• 401(k) savings plan
• Pension plan
• Paid time off
• Paid parental leave
• Disability insurance
• Supplemental life insurance
• Employee assistance program
• Paid holidays
• Tuition reimbursement
• Other incentives

Base Pay Range $17.75 - $26.17 Exact compensation may vary based on skills, experience, and location.

EMPLOYMENT STATEMENT

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

ABOUT HCSC

For more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities. Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren’t afraid to make innovative contributions. We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity you’ll have to improve health care delivery in an open, collaborative environment.

ACCOMMODATIONS

If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at 1-866-977-7378 to request reasonable accommodations. Please note that only requests for accommodations in the application process will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "candidate home" to view your job submissions.

Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma, and Blue Cross and Blue Shield of Texas, Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, and Independent Licensee of the Blue Cross and Blue Shield Association Copyright 2025 Health Care Service Corporation. All Rights Reserved.