Claims Processor, Intermediate

Blue Shield of CA; Rancho Cordova (CA); Hybrid; USD 65,000 - 90,000; Full time

Job summary

The Blue Shield of California is seeking a Claims Processor, Intermediate to review and adjudicate claims and adjustments for members and providers. You will work under the Operations Supervisor and ensure decisions align with contracts and policy requirements.

In this role you will support end-to-end claim life cycle, handle complex edits, and use Excel, Outlook, PowerPoint, and Word to prepare documentation. This position offers a hybrid work arrangement with periodic office presence as needed.

Qualifications

• 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.

Responsibilities

• Review and adjudicate claims and/or adjustments in accordance with provider contracts and organizational policies and procedures.
• Meet operational, financial, and service requirements.
• Collaborate with involved teams to resolve complex edits and discrepancies.

Education

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

Understands fundamentals of end-to-end claims processing

Experienced in back-end processing, proficient in resolving complex edits

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 our 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.

Your Knowledge and Experience

Claims Processor, Intermediate

• 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.