FACETS Claims Specialist: Precision Adjudication

Acumen Group; United States; On-site; USD 60,000 - 80,000; Full time

Job summary

A healthcare solutions provider is seeking an experienced FACETS Claims Specialist to manage claims processing and adjudication for BCBS/Anthem plans. The role requires a minimum of 3 years of experience in claims processing, particularly with FACETS systems. Ideal candidates should be detail-oriented with excellent accuracy and a strong understanding of claims adjustments and regulatory compliance. This position emphasizes collaboration with internal teams to ensure efficient resolution of discrepancies.

Qualifications

• Minimum 3 years of experience in claims processing or adjudication.
• Expertise with FACETS and BCBS/Anthem plans.
• Strong knowledge of claims adjustments and insurance regulations.

Responsibilities

• Review and process claims in FACETS with attention to detail.
• Adjudicate and adjust claims.
• Ensure claims are processed accurately and efficiently, maintaining a 99% accuracy rate.
• Collaborate with internal teams to resolve claim discrepancies.

Skills

Claims processing

Attention to detail

Collaboration

Tools

FACETS

BCBS/Anthem plans

Job description

A healthcare solutions provider is seeking an experienced FACETS Claims Specialist to manage claims processing and adjudication for BCBS/Anthem plans. The role requires a minimum of 3 years of experience in claims processing, particularly with FACETS systems. Ideal candidates should be detail-oriented with excellent accuracy and a strong understanding of claims adjustments and regulatory compliance. This position emphasizes collaboration with internal teams to ensure efficient resolution of discrepancies.