Claims Adjuster

ADP

King of Prussia (PA)

Hybrid

USD 48,000 - 62,000

Full time

7 days ago

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Benefits offered by this job

Remote work

Travel opportunities

Generous PTO

Job summary

Blue Cross Blue Shield Global Solutions (BCBS Global Solutions) is hiring a Claims Adjuster in King of Prussia, PA. The role analyzes and processes adjustments to medical insurance claims, ensuring accuracy and adherence to SLAs. Flexibility to work office or remote is available.

The candidate should have strong communication skills, knowledge of CPT/ICD-9 coding, and experience in the health insurance industry. Training and collaboration with internal teams are expected.

Qualifications

High school diploma or equivalent required; some college/degree a plus.
Three+ years experience in health insurance claim adjudication or related area.
Familiarity with CPT and ICD-9 coding; CPC/CCS certifications desirable.

Responsibilities

Perform retrospective claim adjustments including overpayments/underpayments and system issues.
Analyze inquiries to identify required claim adjustments and process claims accordingly.
Communicate adjudication analyses to internal teams, members, and providers.
Maintain production and quality standards and report error trends for training.

Skills

Verbal communication

Written communication

Problem solving

Organization

Decision making

Microsoft Office

Internal software systems

Computer literacy

Time management

Education

High school diploma or equivalent

Tools

Microsoft Office

CRM/Salesforce

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Regular Full-Time Professional King of Prussia, PA, US

Salary: $23.23 Annually

Who we are:

At Blue Cross Blue Shield Global Solutions (BCBS Global Solutions), we make it easy for people and organizations to access and pay for healthcare abroad. By combining digital innovation with human-centered care, we go above and beyond for our customers and deliver an international healthcare experience that’s simple, efficient, and human.

Whether our customers live, work, travel, or study abroad, we give them the confidence and peace of mind to say “yes” to new possibilities.

We are hiring for a Claims Adjuster to join the team! The Claims Adjuster analyzes and processes requests and inquiries for adjustments to medical insurance claims in an accurate and timely manner while adhering to claims processing standards and Service Level Agreements. This position must be able to adequately communicate findings and be able to assist with escalated issues, and special projects.

Responsibilities:

Performs retrospective claim adjustments that include identifying overpayments, underpayments, system configuration issues and correcting as appropriate.

Analyze external and internal inquiries to identify required claim adjustments.

Process claims as needed by analyzing international claims to identify the claimant, type of services rendered and charge for each and comparing each claim to customer’s policy coverage provisions.

Communicate claim adjudication and/or adjustment analyses to internal departments, internal teams, members, and providers.

Accurately process medical claim adjustments into the claims system in adherence to BCBS Global Solutions SM /HTH standards.

Reporting error trends that are detected for future educational training purposes.

Maintaining required departmental production and quality standards.

Keep Manager advised of status of workload and identify problems for which help is needed.

Follow regulations and company rules and policies as outlined in the Employee Handbook.

Other duties as assigned.

Requirements:

High school diploma or equivalent required. Some college/degree a plus.

Minimum - three years of experience in the health insurance industry examining and adjudicating medical claims preferably with exposure to stating plan features and benefits and helping to resolve claims related issues.

Familiarity with insurance products and insurance terminology, including CPT and ICD-9 coding. Coding Certificate desired (CPC, CCS).

Excellent verbal and written communication skills and ability to effectively deal with customer complaints and concerns.

Work organization, problem solving, and basic math skills.

Ability to make decisions and support them with documentation.

Knowledge of, and the ability to learn: Microsoft Office Products, Internal software systems, the internet and overall familiarity with personal computers is required, as well as the ability to work with dual computer monitors preferred.

Salesforce experience a plus.

Employee is required to have at minimum an internet speed of 75 Mbps (standard high-speed internet access).

Working Conditions:

Flexibility to work in an office and/or at-home, remote office environment.

Overtime and/or schedule flexibility are occasionally necessary in this position. Individual may be required to attend key business/departmental meetings and/or perform certain business critical job functions outside of normal working hours.