Hybrid Claims Analyst, Intermediate – Med Plans

Blue Shield of CA; Redding (CA); Hybrid; USD 54,000 - 75,000; Full time

Job summary

Blue Shield of California seeks a Claims Processor, Intermediate to join the Claims team. You will review and adjudicate claims and adjustments in line with provider contracts and organizational policies to meet service and financial requirements.

Our leadership model focuses on growing leaders at all levels and empowering your personal and professional development. The role emphasizes critical thinking, high-performing teamwork, and continuous learning in a hybrid work environment.

Qualifications

• High School Diploma or GED or 1 year of additional relevant experience in lieu of a diploma.
• Requires 3 years of relevant experience.
• Knowledge of medical plans and benefits.
• Requires basic job knowledge of systems and procedures within Claims Processing.
• Understands fundamentals of end-to-end (life of a claim) claims processing.
• Experienced in back-end processing, proficient in resolving complex edits.
• Intermediate-Advanced skills creating documents/files using Excel, Outlook, PowerPoint, and Word.

Responsibilities

• Review and adjudicate claims and/or adjustments in accordance with provider contracts and organizational policies.
• Support claims processing operations to meet financial and service requirements.

Skills

Claims processing

Excel

Outlook

PowerPoint

Word

Education

High School Diploma or GED or 1 year of additional relevant experience in lieu of a diploma

Tools

Excel

Outlook

PowerPoint

Word

Job description

Blue Shield of California seeks a Claims Processor, Intermediate to join the Claims team. You will review and adjudicate claims and adjustments in line with provider contracts and organizational policies to meet service and financial requirements.

Our leadership model focuses on growing leaders at all levels and empowering your personal and professional development. The role emphasizes critical thinking, high-performing teamwork, and continuous learning in a hybrid work environment.