Claims Processor, Specialist

Blue Shield of CA; Lodi (CA); Hybrid; USD 85,000 - 110,000; Full time

Job summary

Blue Shield of CA in California is seeking a Claims Processor, Specialist to join our hybrid team. You will ensure claims are processed accurately and timely and coordinate with other departments and vendors involved in the claims cycle.

The role reports to the Operations Manager and requires strong Excel/Office skills and a deep understanding of end-to-end health plan processing. Our leadership model develops leaders at all levels and supports personal, professional, and financial growth.

Qualifications

• High School Diploma or GED or 1 year of relevant experience.
• 7 years of prior relevant experience required.
• Thorough knowledge of advanced health plan processing operations and procedures within Claims Processing with a deep understanding of end-to-end claims processing fundamentals required.
• Advanced-Expert skills creating documents/files using Excel, Outlook, Power Point, and Word required.

Responsibilities

• Process and ensure accurate, timely health claim processing.
• Interface with other departments and vendors involved in the claims process.
• Serve as the primary contact for priority claim cases.
• Collaborate with leadership to develop great leaders at all levels and foster continuous learning.

Skills

Excel

Outlook

PowerPoint

Word

Education

High School Diploma or GED

Job description

Your Role

The Claims operational teams are responsible for ensuring claims are processed accurately and timely. The Claims Processor, Specialist will report to the Operations Manager. In this role you will be responsible for interfacing with other departments and vendors involved in the Claims process and will also serve as the primary point of contact for priority claim cases.

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

• High School Diploma or GED or 1 year of additional relevant experience in lieu of a diploma required
• 7 years of prior relevant experience required
• Thorough knowledge of advanced health plan processing operations and procedures within Claims Processing with a deep understanding of end-to-end claims processing fundamentals required
• Advanced-Expert skills creating documents/files using Excel, Outlook, Power Point, and Word required

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.