Claims Examiner: Adjudication & Complex Claims

Excellus BCBS; Town of De Witt (NY); Hybrid; USD 29,000 - 41,000; Full time

Benefits offered by this job

Remote work option

Job summary

Excellus BCBS is seeking a Claims Examiner to resolve a wide range of claims transactions, including entry, adjudication, and adjustments. The role supports MTM measures and NCQA requirements while maintaining member privacy and high service standards.

The position offers multiple levels of accountability and opportunities for learning, with potential remote work on a case-by-case basis and a focus on accuracy and regulatory compliance within a health plan environment.

Qualifications

• High School diploma or equivalent required.
• NYS Independent Adjuster License and renewal maintenance required.

Responsibilities

• Handle front end transactions including member eligibility, entry of claims, member & provider matching and claim processing.
• Identify patterns that impact quality, claim inventory, and/or the customer experience and escalate for review.
• Identify potential trends and escalate for investigation/solution.
• Process, enter, adjudicate and/or adjust and research claims according to policies and contracts.

Skills

customer service

claims processing

multi-tasking

attention to detail

problem-solving

communication skills

Education

High School diploma or equivalent

NYS Independent Adjuster License

Job description

Excellus BCBS is seeking a Claims Examiner to resolve a wide range of claims transactions, including entry, adjudication, and adjustments. The role supports MTM measures and NCQA requirements while maintaining member privacy and high service standards.

The position offers multiple levels of accountability and opportunities for learning, with potential remote work on a case-by-case basis and a focus on accuracy and regulatory compliance within a health plan environment.