Claims Specialist I: Benefits & COB Processing

Bcbsla; Louisiana; On-site; USD 42,000 - 70,000; Full time

Job summary

BCBSLA is seeking a Claims Specialist I to support the claims unit by processing edits, determining primacy for COB, adjusting previously paid claims and initiating overpayment recovery. The role requires attention to regulatory compliance and strong communication with internal teams and external providers.

Responsibilities include researching COB, reviewing denial codes, and ensuring accurate claim records, with emphasis on accuracy and customer satisfaction.

Qualifications

• High School Diploma or equivalent required.
• 6 months of experience in medical claims or health insurance-related customer service or completion of BCBSLA COB training.
• Strong analytical ability and good oral and written communication skills.
• Working knowledge of relevant PC software.

Responsibilities

• Recalculate benefits for previously processed claims and process edits or refunds per benefits rules.
• Identify denial codes, processing codes, and COB coordination for both coordinated and non-coordinated claims.
• Communicate with internal and external contacts to establish sound claim records.
• Review quality audits within 48 hours to ensure accuracy and customer satisfaction.
• Research order of benefits and correct COB records; notify Medicare when primacy is misapplied.
• Assist in training, implementations and documentation as needed.

Skills

Analytical ability

Oral communication

Written communication

Human relations

Education

High School Diploma or equivalent

Tools

PC software

Job description

BCBSLA is seeking a Claims Specialist I to support the claims unit by processing edits, determining primacy for COB, adjusting previously paid claims and initiating overpayment recovery. The role requires attention to regulatory compliance and strong communication with internal teams and external providers.

Responsibilities include researching COB, reviewing denial codes, and ensuring accurate claim records, with emphasis on accuracy and customer satisfaction.