Claims Specialist I

Arkansas Blue Cross and Blue Shield; Arkansas; Ibrido; USD 27.000 - 35.000; Tempo pieno

Vantaggi offerti da questo lavoro

Tuition reimbursement

Onsite gym

Green Leaf Grill

Wellness incentives

Descrizione del lavoro

Arkansas Blue Cross and Blue Shield is seeking a Claims Specialist to resolve non-auto-adjudicated medical claims in a timely and accurate manner, following divisional standards. The role involves data entry, benefit interpretation, and communications with providers to obtain required information.

The position is 100% remote with a preference for Arkansas, Utah, Idaho, and North Dakota residents. Requires a high school diploma and 2 years of college coursework (or equivalent) with proficiency in

Competenze

• High School diploma or equivalent.
• Two years of college coursework (48 semester hours) or equivalent certification with emphasis in anatomy, medical terminology, math, biology, or related field.
• Or minimum one year of related office experience such as claims processing, health insurance, or medical office.
• Must pass claims proficiency test: Claims Assessment.

Mansioni

• Process claims not auto-adjudicated by entering data and reviewing contract benefits; conduct edit and audit resolution; determine benefit eligibility.
• Identify and research processing issues through systems and manuals; route claims to other areas as needed.
• Consult internal staff and medical providers; generate correspondence and forms to obtain information.

Conoscenze

Oral & Written Communications

Strong Interpersonal skills

Sound Judgement

Decision Making

Detail-Oriented

Teamwork

Dependability

Clinical Judgment

Computer Work

Critical Thinking

Customer Service

Evaluating Information

Interpersonal Communication

Oral Communications

Organizing

Process Information

Reading Comprehension

Researching

Time Management

Formazione

High School diploma or equivalent

Two years college coursework in anatomy, medical terminology, math, biology, or related field

One year of related office experience

Descrizione del lavoro

Job Summary

The Claims Specialist resolves medical claims that are not automatically adjudicated by the claims processing system in a timely and accurate manner according to divisional standards of quality and productivity. Resolution may include additional investigation or communication in order to obtain necessary information to complete the claim. Outside issues such as peak filing season, systems down time, inclement weather, holidays, and absenteeism may directly affect the volume of work for each Specialist.

Requirements

Education

High School diploma or equivalent.

Experience

Minimum two (2) years' college coursework (48 semester hours) or other equivalent certification with an emphasis in anatomy, medical terminology, math, biology, or a related field. OR minimum one (1) year of related office experience such as claims processing, health insurance, or medical office. Must pass company proficiency test: Claims Assessment.

Essential Skills & Abilities

• Oral & Written Communications
• Strong Interpersonal skills
• Sound Judgement
• Decision Making
• Detail-Oriented
• Teamwork
• Dependability

Location

This role is 100% remote. Preference will be given to current employees and candidates who reside in Arkansas, Utah, Idaho, and North Dakota.

Skills

• Clinical Judgment
• Computer Work
• Critical Thinking
• Customer Service
• Decision Making
• Evaluating Information
• Interpersonal Communication
• Oral Communications
• Organizing
• Process Information
• Reading Comprehension
• Researching
• Time Management

Responsibilities

• Claims Processing: Claims processing involves the actions required to pay or deny pended claims (those which did not auto-adjudicate), including: entering data into the system; reviewing and interpreting contract benefits; conducting edit and audit resolution; determining benefit eligibility; Identifying and researching processing issues through systems and manuals; routing claims to other areas; consulting internal staff and medical providers; generating correspondence; and completing forms to obtain necessary information
• Knowledge/Continuous Learning: In order to perform the actions required of the Claim Specialist job, the incumbent must undergo initial training, on-the-job training, and continuing education. Demonstrating knowledge of and possessing the ability to access all relevant computer systems and screens in order to process claims accurately; staying current with continually changing processing procedures, benefits, and system modifications; being knowledgeable of and able to meet corporate and national (MTM) standards while maintaining acceptable performance levels based on established departmental standards for productivity and quality; and showing familiarity with corporate and professional manuals and guidebooks, including the company processing manual and ICD, CPT, and HCPS codebooks
• Other duties: As assigned

Hiring Range

$19.77 - $25.68

Security Requirements

This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual. Segregation of Duties Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual.

Employment Type Regular ADA Requirements

1.1 General Office Worker, Sedentary, Campus Travel - Someone who normally works in an office setting or remotely and routinely travels for work within walking distance of location of primary work assignment.

Why? We Love our Employees

Arkansas Blue Cross is consistently ranked as one of the best places to work in Central Arkansas.

• Tuition reimbursement.
• Club Blue, a free, onsite gym to encourage exercise.
• Green Leaf Grill and Green Leaf Grill Express, onsite restaurants in Little Rock that promote healthy eating.
• Incentives for wellness education and exercise

We Love our Culture

The average tenure is 10 years with hundreds of employees having been here 15 years or longer. Our inclusive culture brings employees together to connect while celebrating our differences.

We Love our Community

Our employees often volunteer within their communities, at charity events, walks and runs, schools and nonprofits. When disasters strike, our employees help wherever they are needed. It’s just another way we show that Blue cares.