Claims Resolution Specialist

Arkansas Blue Cross and Blue Shield; Arkansas; Hybrid; USD 42,000 - 54,000; Full time

Job summary

Arkansas Blue Cross and Blue Shield is seeking a Claims Specialist to resolve medical claims that are not automatically adjudicated by the processing system, ensuring timely and accurate outcomes. You will review contract benefits, perform edits, and communicate with providers as needed to obtain required information.

The role emphasizes strong written and verbal communication, attention to detail, and the ability to work with confidential information in a team environment.

Qualifications

• High school diploma or equivalent required.
• Minimum two (2) years' college coursework (48 semester hours) or related certification with emphasis in anatomy, medical terminology, math, biology, or related field.
• Or minimum one (1) year of related office experience such as claims processing, health insurance, or medical office.

Responsibilities

• Claims Processing: pay or deny pended claims (not auto-adjudicated) and enter data into the system.
• Review and interpret contract benefits and perform edit and audit resolution.
• Identify and research processing issues and route claims to appropriate areas.

Skills

Oral & Written Communications

Interpersonal Skills

Judgement

Decision Making

Detail-Oriented

Teamwork

Dependability

Clinical Judgment

Computer Work

Critical Thinking

Customer Service

Reading Comprehension

Time Management

Organizing

Researching

Education

High School diploma

48 semester hours or related certification (anatomy, medical terminology, math, biology)

Tools

ICD CPT HCPCS codebooks

Job description

Arkansas Blue Cross and Blue Shield is seeking a Claims Specialist to resolve medical claims that are not automatically adjudicated by the processing system, ensuring timely and accurate outcomes. You will review contract benefits, perform edits, and communicate with providers as needed to obtain required information.

The role emphasizes strong written and verbal communication, attention to detail, and the ability to work with confidential information in a team environment.