Hybrid Claims Processor, Intermediate — Adjudication

Blue Shield of CA; Springfield Meadows (CA); Hybrid; USD 52,000 - 78,000; Full time

Job summary

Blue Shield of California is seeking an experienced Intermediate Claims Processor to review and adjudicate claims and adjustments for members served in and outside California. You will work under the Operations Supervisor to ensure contracts, policies, and procedures are followed to meet operational and financial goals.

The role emphasizes analytical accuracy, end-to-end claims lifecycle understanding, and proficiency with Excel, Outlook, PowerPoint, and Word.

Qualifications

• Requires a high school diploma or GED; 1 year of additional relevant experience can substitute for a diploma.
• Requires 3 years of relevant experience in claims processing.
• Knowledge of medical plans and benefits; understanding end-to-end claims lifecycle.

Responsibilities

• Review and adjudicate claims and/or adjustments in accordance with provider contracts and organizational policies.
• Meet operational, financial, and service requirements while processing claims.
• Maintain accuracy by resolving complex edits and ensuring proper documentation.
• Collaborate with the Operations Supervisor and team to ensure consistent outcomes.

Skills

Claims processing

Edits resolution

Excel

Outlook

PowerPoint

Word

Education

High School Diploma or GED

1 year relevant experience in lieu of diploma

Job description

Blue Shield of California is seeking an experienced Intermediate Claims Processor to review and adjudicate claims and adjustments for members served in and outside California. You will work under the Operations Supervisor to ensure contracts, policies, and procedures are followed to meet operational and financial goals.

The role emphasizes analytical accuracy, end-to-end claims lifecycle understanding, and proficiency with Excel, Outlook, PowerPoint, and Word.