Claims Examiner: Resolve & Adjudicate Diverse Claims

Excellus BCBS; City of Binghamton (NY); A distancia; USD 28.000 - 45.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Remote work option

Descripción de la vacante

Excellus BCBS in the United States is seeking a Claims Examiner to handle a wide range of claims transactions, including entry, adjudication and adjustments in line with MTM, NCQA and PIP policies.

The role progresses through Level I–IV with emphasis on accuracy, collaboration, and ongoing learning. A High School diploma and prior claims processing or customer service experience are required.

Formación

• High School diploma or equivalent required.
• Relevant customer service or claims processing experience preferred.
• Able to navigate multiple programs/windows concurrently.
• Proven ability to manage moderately complex claims.

Responsabilidades

• Handle front end transactions including member eligibility and claim processing.
• Adjudicate, adjust and research claims per policy and procedures.
• Identify trends, escalate issues and collaborate with internal teams.
• Maintain privacy and adhere to corporate guidelines and codes of conduct.
• Demonstrate professionalism, self-direction and attention to quality output.
• Provide learning opportunities and knowledge sharing with peers.

Conocimientos

Claims processing

Customer service

Attention to detail

Multi-tasking

Windows

Educación

High School diploma or equivalent

Descripción del empleo

Excellus BCBS in the United States is seeking a Claims Examiner to handle a wide range of claims transactions, including entry, adjudication and adjustments in line with MTM, NCQA and PIP policies.

The role progresses through Level I–IV with emphasis on accuracy, collaboration, and ongoing learning. A High School diploma and prior claims processing or customer service experience are required.