Hybrid/Remote Claims Adjudication Specialist

Blue Cross and Blue Shield of North Carolina; Virginia (MN); Hybrid; USD 42,000 - 67,000; Full time

Benefits offered by this job

Medical/dental/vision coverage

Annual incentive bonus

401k with employer match

PTO and wellness programs

Parental leave

Job summary

Blue Cross and Blue Shield of North Carolina is seeking a Claims Representative to join the Claims Team. Under direct supervision, you will review and adjudicate claims and administer them in accordance with contractual benefits and health care policies.

You will manage daily work queues, monitor claim turnaround times, respond to inquiries from subscribers, providers, physicians and other carriers, and strive to meet quality and performance standards.

Qualifications

• High school diploma or GED required.
• 0–2 years in related field.

Responsibilities

• Process, adjust or update routine claims payments and payment errors for singular business segment and/or claims-provider type.
• Respond promptly and accurately to inquiries from subscribers, providers, physicians and other insurance carriers regarding claims payments.
• Meet or exceed established quality and performance standards.
• Determine suspended claim resolution methods by reviewing benefit eligibility, claims history and other information.
• Identify system problems, including documentation of the issue, recommendation of potential solutions, referral to appropriate technical staff and follow-up to ensure resolution.
• Assist management by identifying and analyzing opportunities for improvements in BCBSNC processes, policies and services.
• May coordinate with other insurance carriers and Medicare to determine BCBSNC payment liability.
• Review claims for possible "fraud and abuse" and send to Special Investigations Unit for additional investigation.

Skills

Claims Adjudication

Claims Analysis

Customer Service

Claims Processing

Education

High school diploma or GED

Tools

Medical Claims Processing

Job description

Blue Cross and Blue Shield of North Carolina is seeking a Claims Representative to join the Claims Team. Under direct supervision, you will review and adjudicate claims and administer them in accordance with contractual benefits and health care policies.

You will manage daily work queues, monitor claim turnaround times, respond to inquiries from subscribers, providers, physicians and other carriers, and strive to meet quality and performance standards.