Claims Processor, Intermediate

Blue Shield of California; California; Hybrid; USD 28,000 - 39,000; Full time

Benefits offered by this job

Hybrid work model

Job summary

Blue Shield of California is seeking a Claims Processor, Intermediate to review and adjudicate claims and adjustments for services in and outside California. The role reports to the Operations Supervisor and focuses on meeting operational, financial, and service requirements while supporting a high-performing team.

The position offers hybrid virtual work with in-office requirements based on business needs; candidates should have strong back-end processing experience and advanced Excel/Office

Qualifications

• HS Diploma or GED or 1 year of relevant experience in lieu of a diploma
• 3 years of relevant experience
• Knowledge of medical plans and benefits
• Basic knowledge of systems and procedures within Claims Processing
• Understands fundamentals of life of a claim processing
• Experience in back-end processing and resolving complex edits
• Intermediate-Advanced skills creating documents/files using Excel, Outlook, PowerPoint, and Word

Responsibilities

• Be experienced in back-end processing; proficient in resolving complex edits using available documents/job aids with minimum direction
• Experience front-end processing and difficult adjustments and multiple claim types
• Be given special processing assignments; coordinate with other departments for resolution if needed
• Coordinate with internal partners to resolve processing issues requiring cross-functional input
• Apply working knowledge of end-to-end claims processing to meet quality and productivity standards
• Provide claims support within the Commercial, IFP, Medicare, Medi-Cal, FEP, ITS Home, ITS Host, or CalPERS lines of business
• Other duties as assigned

Skills

End-to-end claims processing

Knowledge of medical plans andBenefits

Cross-functional collaboration

Strong Excel/Office skills

Education

High School Diploma or GED

Tools

Excel

Outlook

PowerPoint

Word

Job description

Your Role

The Blue Shield of California Claims teams process claims and adjustments for Blue Shield of California members that receive services performed in, or outside of California. The Claims Processor, Intermediate will report to the Operations Supervisor. In this role you will be responsible for reviewing and adjudicating claims and/or adjustments in accordance with provider contracts and organizational policies and procedures to meet operational, financial, and service requirements.

Job Description

Your Role

The Blue Shield of California Claims teams process claims and adjustments for Blue Shield of California members that receive services performed in, or outside of California. The Claims Processor, Intermediate will report to the Operations Supervisor. In this role you will be responsible for reviewing and adjudicating claims and/or adjustments in accordance with provider contracts and organizational policies and procedures to meet operational, financial, and service requirements.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Responsibilities

Your Work

In this role, you will:

• Be experienced in back-end processing; proficient in resolving complex edits using available. documents/job aids with minimum direction.
• Experience front-end processing and difficult adjustments and multiple claim types.
• Be given special processing assignments; coordinate with other departments for resolution if needed.
• Coordinate with internal partners to resolve processing issues requiring cross-functional input.
• Apply working knowledge of end-to-end claims processing to meet quality and productivity standards.
• Provide claims support within the Commercial, IFP, Medicare, Medi-Cal, FEP, ITS Home, ITS Host, or CalPERS lines of business.
• Other duties as assigned.

Future Opportunities

Great talent is always in demand at Blue Shield of California. While there is not a current opening associated with this posting, we are proactively building a network of qualified candidates for future opportunities. We encourage you to apply and stay connected for upcoming roles that align with your skills and interests.

Qualifications

Your Knowledge and Experience

• Requires High School Diploma or GED or 1 year of additional relevant experience in lieu of a diploma
• Requires 3 years of relevant experience
• Knowledge of medical plans and benefits
• Requires basic job knowledge of systems and procedures within Claims Processing
• Understands fundamentals of end-to-end (life of a claim) claims processing
• Experienced in back-end processing, proficient in resolving complex edits
• Intermediate-Advanced skills creating documents/files using Excel, Outlook, PowerPoint, and Word

Hybrid Virtual Work

This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.

About Us

About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!

Our Values:

• Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model

We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:

• For most teams, this means coming into the office two days per week.
• Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
• For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.

Physical Requirements

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Equal Employment Opportunity

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

JOB INFO

Job Identification : 20261891

Job Category : Customer Services and Operations

Posting Date : 2026-10-07T16:33:30+00:00

Job Schedule : Full time

Locations :

Redding, CA, United States

El Dorado Hills, CA, United States

Lodi, CA, United States

Rancho Cordova, CA, United States

Pay Range for California : $20.13 to $28.18

Pay Range for Bay Area : $22.69 to $31.76

Note : Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate experience, location (California, Bay Area, or outside California), and current employee salaries for similar roles.

Role can be filled by a candidate requiring sponsorship : No