OPL Claims Correspondent

Blue Cross and Blue Shield of Kansas; United States; Hybrid; USD 30,000 - 37,000; Full time

Benefits offered by this job

Incentive pay program (EPIP)

Health/Vision/Dental insurance

6 weeks paid parental leave for new...

Fertility/Adoption assistance

2 weeks paid caregiver leave

401(k) plan matching up to 5%

Tuition reimbursement

Health & fitness benefits, discounts

Job summary

Blue Cross and Blue Shield of Kansas seeks an OPL Claims Correspondent to investigate and manage complex claims involving overlapping or duplicate coverage, auto/no-fault, workers’ compensation and subrogation. Responsibilities include research, adjustments, and detailed recordkeeping.

Position permits remote or onsite work under our Telecommuting Policy and requires Kansas/Missouri residency or relocation.

Qualifications

• High school diploma or equivalent required.
• Minimum 1 years’ experience of claims processing required.
• Minimum 1 years’ experience of BCBSKS Customer Service experience required.

Responsibilities

• Research and investigate claims to determine payment liability.
• Load notes/trailers from research for OPL investigations.
• Maintain detailed records of claims researched for audits or reviews.
• Refer claims for adjustments as needed for corrective action.
• Keep up to date on state law, contracts and policy guidance.

Skills

Verbal communication

Written communication

Attention to detail

Education

High school diploma or equivalent

Tools

Imaging

ACES

OTIS

MASK

Outlook

TROVE

Check Free

IS12

Client Letter

ITS

CSI

Membership system

Job description

Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.

Why Join Us?

• Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
• Family Comes First: Total rewards package that promotes the idea of family first for all employees. Paid vacation and sick leave with paid maternity and paternity available immediately upon hire
• Professional Growth Opportunities: Advance your career with ongoing training and development programs.
• Dynamic Work Environment: Collaborate with a team of passionate and driven individuals in a work environment that promotes flexibility.
• Trust and Stability: Work for one of the most trusted companies in Kansas with over 80 years of commitment, compassion and community.
• Inclusive Work Environment: We pride ourselves on fostering a workplace where everyone is valued and respected.

Benefits & Perks

Base compensation is only one component of your competitive Total Rewards package

• Incentive pay program (EPIP)
• Health/Vision/Dental insurance
• 6 weeks paid parental leave for new mothers and fathers
• Fertility/Adoption assistance
• 2 weeks paid caregiver leave
• 401(k) plan matching up to 5%
• Tuition reimbursement
• Health & fitness benefits, discounts and resources

Job Summary

The OPL Claims Correspondent investigates and manages complex claims involving overlapping or duplicate coverage, auto/no-fault, workers’ compensation and subrogation. By performing OPL investigations, calculations, coordinating adjustments, and ensuring accurate claim resolution, the role supports efficient, accurate and compliant claims operations.

Work Location

This position is eligible to work remotely or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.

What you’ll do

• Research and investigate claims received to determine payment liability (Other Party Liability issues).
• Determine OPL situations and properly load the appropriate notes/trailers from research on claims based on information received from insureds, providers, other insurance companies and outside vendors.
• Handles online claim maintenance to records which result in system “kick-outs” of claims needing OPL investigation to allow the accurate payment of claims.
• Analyzes inquiry and conducts research to determine appropriate action on claims when OPL is involved.
• Initiates phone calls to outside entities to obtain eligibility information or clarify OPL circumstances.
• Remains current on state law, corporate contract and policy, and NAIC guidelines relative to the application of contract benefits for auto/no-fault, worker’s compensation, duplicate coverage and subrogation.
• Maintain detailed and accurate records of all claims researched, including documentation for audits or reviews.
• Refer claims for adjustments as needed for corrective action.

What you’ll need

Education

• High school diploma or equivalent required

Experience

• Minimum 1 years’ experience of claims processing experience required or
• Minimum 1 years’ experience of BCBSKS Customer Service experience required

Travel

• No travel

Knowledge, Skills and Abilities

• Upon completion of training, must be knowledgeable of all Claims and Membership policies, operating procedures, professional and institutional policies, contracts for all lines of business/product lines and benefit coding.
• Upon completion of training, knowledge of NAIC OPL regulations, workers’ compensation laws, Kansas Automobile Injury Reparations Act and subrogation.
• Effective verbal, written and human relation skills.
• Current knowledge on state law, corporate contract and policy, and NAIC guidelines relative to application of contract benefits for auto no-fault, workers’ compensation, duplicate coverage and subrogation.
• Upon completion of training, knowledge of the following systems is required: Imaging, ACES, OTIS, MASK, Outlook, the FEP Washington system, TROVE, provider files, Check Free, IS12 (table inquiry), Client Letter, ITS system, CSI and the Membership system.

Compensation

$21.46 - $26.83 hourly
Non - Exempt 11

• Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual’s skills, education, experience, and training. The range may vary above or below the stated amounts.

Our Commitment to Connection and Belonging

At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law.

At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law.

Blue Cross and Blue Shield of Kansas conducts pre-employment drug screening, criminal conviction check, employment verifications and education as part of a conditional offer of employment.