Claims Payment Specialist

BCBS Global Solutions; King of Prussia (PA); Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Hybrid work model

Paid parental leave

Telemedicine services

401(k) match

Tuition reimbursement

Employee assistance

Healthcare coverage

Job summary

BCBS Global Solutions seeks a Claims Payment Specialist to investigate and resolve payment issues across returned, rejected, and suspended reimbursements. You will coordinate with members, providers, and internal teams to ensure accurate processing and timely communications.

The role emphasizes attention to detail, data integrity, and proactive problem-solving in a hybrid work environment across US operations, with opportunities for growth and professional development.

Qualifications

• High school diploma or equivalent; further education is a plus.
• 1–2 years in customer-facing, administrative, claims, finance, or operations.
• Strong organization, problem-solving, and data entry skills.
• Ability to decide based on research and documentation.
• Clear written and verbal communication; proficient with Microsoft Office.

Responsibilities

• Analyze returned, rejected, suspended, and failed claim reimbursements.
• Review payment and claims data to identify discrepancies.
• Research and resolve payment exceptions with updated details.
• Coordinate reissuance of claim payments after corrective actions.
• Maintain professional communication with members, providers, and internal teams.
• Document findings and actions for audits and compliance.
• Support payment policy adherence and process improvements.

Skills

Attention to detail

Data entry

Problem solving

Communication

Organizational skills

Education

High School Diploma

Tools

Microsoft Office

Job description

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.

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.

What we're looking for in our Claims Payment Specialist:

You're someone who enjoys solving problems, investigating details, and ensuring payments are handled accurately from start to finish. You thrive in a process-driven environment and take pride in delivering a positive experience for members, providers, and internal partners. You're naturally curious, organized, and committed to finding solutions when payment issues arise.

You're someone who:

• Has a strong attention to detail and enjoys researching discrepancies
• Takes ownership of issues and follows through to resolution
• Communicates effectively with customers, providers, and cross-functional teams
• Balances quality, accuracy, and productivity in a fast-paced environment
• Enjoys uncovering root causes and improving outcomes through problem-solving
• Can navigate multiple systems and processes while maintaining organization and accuracy

Payment Investigation & Resolution

• Analyze returned, rejected, suspended, and failed claim reimbursements to determine the cause of payment issues
• Review payment and claims information to identify discrepancies and ensure accurate reimbursement processing
• Research and resolve payment exceptions by updating electronic payment details and mailing information
• Coordinate the reissuance of claim payments after validating corrective actions

Member, Provider & Internal Partner Support

• Contact members and healthcare providers to obtain accurate payment information and address updates
• Serve as a liaison between Claims, Finance, Customer Service, and other internal teams to facilitate payment resolutions
• Request and monitor wire tracers and other payment investigations to support inquiries and issue resolution
• Maintain professional, timely communication with internal and external stakeholders throughout the resolution process

Refund Processing & Financial Accuracy

• Review and analyze refund payments received from members and providers related to overpayments or incorrect reimbursements
• Partner with appropriate teams to ensure proper claim credits and payment adjustments are processed
• Document findings, actions taken, and outcomes to support audit and compliance requirements
• Help ensure payment activity aligns with company policies, procedures, and service standards

Quality, Compliance & Continuous Improvement

• Maintain departmental productivity and quality standards
• Accurately document payment research, decisions, and supporting information
• Identify trends, recurring issues, and opportunities for process improvements
• Support departmental initiatives and other responsibilities as assigned
• Follow all company policies, procedures, and regulatory requirements

This might be the right fit for you if...

• You have a high school diploma or equivalent; additional education or coursework is a plus
• You have 1-2 years of experience in a customer-facing, administrative, claims, finance, accounting, or operations-related role
• You have strong organizational, problem-solving, and data entry skills
• You're comfortable making decisions based on research and supporting documentation
• You communicate clearly and professionally, both verbally and in writing
• You are proficient with Microsoft Office and comfortable learning new systems and technologies
• You can effectively manage multiple priorities while maintaining accuracy and attention to detail

Bonus points if you have:

• Experience with health insurance claims or payment processing
• Exposure to accounting, finance, or reimbursement functions
• Experience working with CRM, claims administration, or payment systems
• Knowledge of healthcare reimbursement processes
• Experience working in a regulated or compliance-focused environment
• Experience supporting remote or cross-functional teams

What you'll get in return:

• Competitive base pay + annual bonus
• Competitive medical plans
• Telemedicine services
• Paid parental leave
• 24/7 employee assistance and wellness support
• Free international healthcare coverage

Other great perks:

• Hybrid work model (office and/or remote)
• Work-abroad arrangements available
• Generous PTO accrual with carry-over options
• 9 paid holidays, plus one floating holiday and one volunteer day
• Tuition reimbursement
• Career development and learning opportunities
• 401(k) with generous company match
• Pet insurance options
• Identity theft and legal coverage
• Ongoing focus on well-being, including virtual wellness resources and mindfulness events

Please visit the employee benefits page on our website for more information on our benefits and perks that support your overall well-being.

EOE