Claims Examiner I

Blue Cross and Blue Shield of Kansas City; Missouri; On-site; USD 42,000 - 64,000; Full time

Benefits offered by this job

Competitive benefits

Paid time off

Tuition reimbursement

Parental leave

Job summary

Blue Cross and Blue Shield of Kansas City is seeking a Claims Processor to assess claim information, reference contracts, and perform calculations to process payments on dental, hospital, medical, ITS, and FEP claims.

Under supervision, you will conduct claim research, adjustments, respond to inquiries, and complete training to meet performance standards while contributing to a high-quality, accurate claims operation.

Qualifications

• High school diploma or GED required.
• 2+ years of customer service, member services, or claims processing experience.
• Strong keyboarding and MS Office skills.

Responsibilities

• Processes claims for dental, hospital, medical, ITS, and FEP.
• Performs claim research and adjustments.
• Handles complex FEP transactions and member appeals.
• Responds to inquiries from internal and external customers.
• Sets up deductions and table entries for finance functions.

Skills

Customer service

Claims processing

Attention to detail

Keyboarding

Education

High school diploma or GED

Associates degree (preferred)

Tools

FACETS

Microsoft Office

Job description

Guided by our core values and commitment to your success, we provide health, financial and lifestyle benefits to ensure a best-in-class employee experience. Some of our offerings include:Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contributeAnnual incentive bonus plan based on company achievement of goalsTime away from work including paid holidays, paid time off and volunteer time offProfessional development courses, mentorship opportunities, and tuition reimbursement programPaid parental leave and adoption leave with adoption financial assistanceEmployee discount programJob Description Summary:Under general supervision, assesses claim information, references contracts and performs calculations and other functions to accomplish the processing and payment of insurance claims of a complicated or non-routine nature. Interprets contract information and communicates with outside parties to obtain information and coordinate coverage. Performs claim research and adjustments.Job DescriptionEACH DUTY AND RESPONSIBILITY MUST BE PERFORMED IN ACCORDANCE WITH INDIVIDUAL PERFORMANCE SCORECARD PRODUCTION AND QUALITY STANDARDS.Successfully completes all training programs as required for the level.Processes claims for two products or claim types (dental, hospital, medical, ITS, FEP).Performs research and adjustment functions for claims.Perform special projects (e.g., complex accumulator reconsiderations, New Directions).Responds to written inquiries from internal and external customers as business needs dictate.Sets up deducts, CLOV table entries, and other assigned finance functions.For FEP positions, processes all deferrals for FEP or edit corrections in computerized claims system.Performs complex FEP transactions (e.g., FEP Direct DDE, FEP Retro-enrollment, Out of Balance) and member appeals.Minimum QualificationsHigh school diploma or general education degree (GED).2 years of previous customer service, member services, or claims processing experience; or any combination of required education and experience.Advanced Keyboarding KnowledgeIntermediate knowledge of Microsoft OfficePreferred QualificationsKnowledge of FACETS and/or other computerized claims processing system as applicable (FEP).Associates degree from college or technical schoolBlue Cross and Blue Shield of Kansas City is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, color, religion, sex, sexual orientation, gender identity, national origin, age, status as a protected veteran, or disability.