Claims Adjudication Specialist (Hybrid/Remote)

Blue Shield of California; California; Hybrid; USD 28,000 - 39,000; Full time

Benefits offered by this job

Hybrid work model

Job summary

Blue Shield of California is seeking a Claims Processor, Intermediate to review and adjudicate claims and adjustments for services in and outside California. The role reports to the Operations Supervisor and focuses on meeting operational, financial, and service requirements while supporting a high-performing team.

The position offers hybrid virtual work with in-office requirements based on business needs; candidates should have strong back-end processing experience and advanced Excel/Office

Qualifications

• HS Diploma or GED or 1 year of relevant experience in lieu of a diploma
• 3 years of relevant experience
• Knowledge of medical plans and benefits
• Basic knowledge of systems and procedures within Claims Processing
• Understands fundamentals of life of a claim processing
• Experience in back-end processing and resolving complex edits
• Intermediate-Advanced skills creating documents/files using Excel, Outlook, PowerPoint, and Word

Responsibilities

• Be experienced in back-end processing; proficient in resolving complex edits using available documents/job aids with minimum direction
• Experience front-end processing and difficult adjustments and multiple claim types
• Be given special processing assignments; coordinate with other departments for resolution if needed
• Coordinate with internal partners to resolve processing issues requiring cross-functional input
• Apply working knowledge of end-to-end claims processing to meet quality and productivity standards
• Provide claims support within the Commercial, IFP, Medicare, Medi-Cal, FEP, ITS Home, ITS Host, or CalPERS lines of business
• Other duties as assigned

Skills

End-to-end claims processing

Knowledge of medical plans andBenefits

Cross-functional collaboration

Strong Excel/Office skills

Education

High School Diploma or GED

Tools

Excel

Outlook

PowerPoint

Word

Job description

Blue Shield of California is seeking a Claims Processor, Intermediate to review and adjudicate claims and adjustments for services in and outside California. The role reports to the Operations Supervisor and focuses on meeting operational, financial, and service requirements while supporting a high-performing team.

The position offers hybrid virtual work with in-office requirements based on business needs; candidates should have strong back-end processing experience and advanced Excel/Office