Claims Representative

bcbsnc; United States; Hybrid; USD 42,000 - 67,000; Full time

Job summary

Blue Cross NC in the United States is seeking a Claims Processor to handle routine payments and respond to inquiries from subscribers, providers, and partners. The role focuses on accuracy, timely resolution, and adherence to quality standards.

This position offers a hybrid work arrangement, a comprehensive benefits package, and opportunities for professional development, with salary in the mid-to-upper range based on experience.

Qualifications

• High school diploma or GED.
• 0-2 years of experience in related field.
• Data entry experience is a plus.

Responsibilities

• Process, adjust or update routine claims payments for a segment and/or claims-provider type.
• Respond promptly to inquiries about claims payments from Core Service, subscribers, providers, physicians and other insurance carriers.
• Meet or exceed established quality and performance standards.
• Determine suspended claim resolution methods by reviewing benefit eligibility, claims history and other information.
• Identify system problems, document issues, and coordinate solutions with technical staff.
• Assist management by identifying opportunities for process improvements.
• May coordinate with other insurance carriers and Medicare to determine BCBSNC payment liability.
• Review claims for possible fraud and abuse and forward to Special Investigations Unit for additional investigation.

Skills

Claims Adjudication

Claims Analysis

Claims Management

Claims Processing

Claims Resolution

Claims Review

Customer Service

Documentations

Insurance

Insurance Claims

Medical Claims Processing

Medicare

Patient Care

Policy Knowledge

Process Improvements

Education

High school diploma or GED

Job description

What You'll Do

• Process, adjust or update various routine claims payments and payment errors for singular business segment and/or claims-provider type
• Respond promptly and accurately to inquiries from Core Service, subscribers, providers, physicians and other insurance carriers regarding claims payments
• Meet or exceed established quality and performance standards
• Determine suspended claim resolution methods by reviewing benefit eligibility, claims history and other information
• Identify system problems, including documentation of the issue, recommendation of potential solutions, referral to appropriate technical staff and follow-up to ensure resolution
• Assist management by identifying and analyzing opportunities for improvements in BCBSNC processes, policies and services
• May coordinate with other insurance carriers and Medicare to determine BCBSNC payment liability
• Review claims for possible "fraud and abuse" and send to Special Investigations Unit for additional investigation

What You've Bring

• High school diploma or GED
• 0-2 years of experience in related field.

Bonus Points (Preferred qualifications)

• Data entry experience is a plus.

What You'll Get

• The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community
• Work-life balance, flexibility, and the autonomy to do great work
• Medical, dental, and vision coverage along with numerous health and wellness programs
• Parental leave and support plus adoption and surrogacy assistance
• Career development programs and tuition reimbursement for continued education
• 401k match including an annual company contribution

Where You'll Work

Our Hybrid Flex approach is built on presence with a purpose - giving you flexibility to work remotely with intentional in-person connection - that supports a workplace that's flexible, connected, and future focused. In a Hybrid-Flex role, you'll work in the office at least two days a week for collaboration and connection. In a Remote Flex role, you'll work virtually, with a few in-office visits each year for meaningful moments that matter. Whether your role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any states listed on this job posting. Onsite expectations will be discussed during the interview process.

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

*Based on annual corporate goal achievement and individual performance.

$41,600.00 - $66,561.00

Skills

• Claims Adjudication
• Claims Analysis
• Claims Management
• Claims Processing
• Claims Resolution
• Claims Review
• Customer Service
• Documentations
• Insurance
• Insurance Claims
• Medical Claims Processing
• Medicare
• Patient Care
• Policy Knowledge
• Process Improvements