Claims Processor, Intermediate

Blue Shield of CA; Springfield Meadows (CA); Hybrid; USD 52,000 - 78,000; Full time

Job summary

Blue Shield of California is seeking an experienced Intermediate Claims Processor to review and adjudicate claims and adjustments for members served in and outside California. You will work under the Operations Supervisor to ensure contracts, policies, and procedures are followed to meet operational and financial goals.

The role emphasizes analytical accuracy, end-to-end claims lifecycle understanding, and proficiency with Excel, Outlook, PowerPoint, and Word.

Qualifications

• Requires a high school diploma or GED; 1 year of additional relevant experience can substitute for a diploma.
• Requires 3 years of relevant experience in claims processing.
• Knowledge of medical plans and benefits; understanding end-to-end claims lifecycle.

Responsibilities

• Review and adjudicate claims and/or adjustments in accordance with provider contracts and organizational policies.
• Meet operational, financial, and service requirements while processing claims.
• Maintain accuracy by resolving complex edits and ensuring proper documentation.
• Collaborate with the Operations Supervisor and team to ensure consistent outcomes.

Skills

Claims processing

Edits resolution

Excel

Outlook

PowerPoint

Word

Education

High School Diploma or GED

1 year relevant experience in lieu of diploma

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.