Claims Processor, Specialist

Blue Shield of CA; Oakland (CA); Hybrid; USD 95,000 - 135,000; Full time

Job summary

Blue Shield of CA is seeking a Claims Processor, Specialist to ensure claims are processed accurately and timely. The role will interface with other departments and vendors, and act as the primary contact for priority claim cases.

Hybrid virtual work setup; employees may need to come to the office based on business needs. This position supports leadership development and opportunities for growth within the organization.

Qualifications

• 7 years of prior relevant experience required.
• Thorough knowledge of advanced health plan processing operations within Claims Processing.

Responsibilities

• Interface with other departments and vendors involved in the Claims process.
• Serve as the primary contact for priority claim cases.

Skills

Claims operations

End-to-end processing

Vendor coordination

Cross-functional liaison

Communication

Education

High School Diploma or GED

Tools

Excel

Outlook

PowerPoint

Word

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.