Claims Processor, Specialist

Blue Shield of CA; San Diego (CA); Hybrid; USD 85,000 - 105,000; Full time

Benefits offered by this job

Hybrid work arrangement

Job summary

Blue Shield of CA is seeking a Claims Processor, Specialist to join our Claims Operations team in California. You will ensure claims are processed accurately and timely and act as the primary contact for priority cases, interfacing with other departments and vendors as needed.

This hybrid role requires 7 years of relevant experience and a strong foundation in health plan processing operations, with advanced skills in Microsoft Office applications.

Qualifications

• 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 end-to-end claims processing.

Responsibilities

• Process claims accurately and timely and interface with other departments and vendors.
• Serve as the primary point of contact for priority claim cases.
• Collaborate with leadership to drive continuous process improvements.

Skills

Claims processing

Education

High School Diploma or GED, or 1 year of relevant experience in lieu of diploma

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.