Claims Research Analyst — Medical Benefits & Inquiries

Blue Cross and Blue Shield of Alabama; Birmingham (AL); On-site; USD 36,000 - 48,000; Full time

Job summary

Blue Cross and Blue Shield of Alabama is hiring a Claims Research Associate Trainee to learn claims processing and inquiry resolution. The role involves reviewing claims, recalculating benefits, and ensuring timely responses to inquiries while adhering to service level agreements.

You will participate in a structured ICMS training program with phased learning, benchmarking, and fluency goals, progressing toward the IACS area after training.

Qualifications

• High School Diploma or equivalent.
• Experience interacting with customers.
• Experience in problem solving and analytical skills.
• Experience with time management and organization.
• Experience researching information using computer or reference materials.
• Willing to work set schedule.
• Strong communication skills, both oral and written.
• Bachelor’s Degree preferred.
• Experience in production, accuracy, and timeliness preferred.
• Experience adjusting to business needs; ICD knowledge preferred.

Responsibilities

• The primary function is medical claims processing and inquiry resolution according to guidelines.
• Review claims for errors and compare member benefits to services requested.
• Analyze claims to recalculate benefits and determine correct payment order.
• Exercise judgement to reject or redirect misrouted information and ask clarifying questions.
• Communicate via inquiry, email and telecommunication across departments for resolution.
• Participate in the ICMS program training phases and transition into IACS.

Skills

Customer service

Problem solving

Time management

Organizational skills

Research

Communication

Keying

ICD knowledge

Education

High School Diploma

Bachelor’s Degree preferred

Job description

Blue Cross and Blue Shield of Alabama is hiring a Claims Research Associate Trainee to learn claims processing and inquiry resolution. The role involves reviewing claims, recalculating benefits, and ensuring timely responses to inquiries while adhering to service level agreements.

You will participate in a structured ICMS training program with phased learning, benchmarking, and fluency goals, progressing toward the IACS area after training.