Hybrid Claims Specialist II — Complex Adjudication

Southcarolinablues; Nashville (TN); Hybride; USD 52 000 - 73 000; Plein temps

Avantages offerts par ce poste

Subsidized health plans

Dental & vision coverage

401k with company match

Life Insurance

PTO

Education Assistance

Service Recognition

National discounts

Résumé du poste

BlueCross BlueShield of South Carolina is seeking a Hybrid- Nashville based Claims IIApply professional responsible for reviewing and adjudicating complex or specialty claims. You will ensure proper coding, maintain quality standards and mentor newer staff in a 40-hour work week.

Requirements include a high school diploma, 2 years claims processing experience, and strong organizational, analytical and communication skills.

Qualifications

• Strong organizational, analytical and judgment abilities.
• Excellent written and verbal communication skills; attention to detail.
• Proficiency in spelling, punctuation and grammar; basic business math.
• Ability to handle confidential or sensitive information with discretion.
• HS diploma or equivalent required.
• At least 2 years of claims processing experience.

Responsabilités

• Review and adjudicate complex or specialty claims.
• Enter claims into the system after verification of procedures and diagnosis codes.
• Verify correct keying of claims and ensure processing meets quality standards.
• Correct processing errors by reprocessing, adjusting or recouping claims.
• Research and resolve claim edits and deferrals; coordinate with internal support areas.
• Respond to routine correspondence and maintain applicable spreadsheets.

Connaissances

Organizational skills

Analytical skills

Judgment

Oral & written communication

Spelling & grammar

Basic math

Discretion with information

Formation

High School Diploma or equivalent

Outils

Microsoft Office

Description du poste

BlueCross BlueShield of South Carolina is seeking a Hybrid- Nashville based Claims IIApply professional responsible for reviewing and adjudicating complex or specialty claims. You will ensure proper coding, maintain quality standards and mentor newer staff in a 40-hour work week.

Requirements include a high school diploma, 2 years claims processing experience, and strong organizational, analytical and communication skills.