OPL Claims Correspondent

bcbsks; United States; Híbrido; USD 30.000 - 37.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Health/Vision/Dental insurance

6 weeks paid parental leave

401(k) plan matching up to 5%

Tuition reimbursement

Health & fitness benefits

Descripción de la vacante

Blue Cross and Blue Shield of Kansas is seeking an OPL Claims Correspondent to investigate and manage complex claims involving overlapping or duplicate coverage, auto/no-fault, workers' compensation and subrogation.

The role requires attention to detail, knowledge of state laws and NAIC guidelines, and the ability to coordinate with insureds, providers and external vendors. Remote or onsite work is available per policy.

Formación

• High school diploma or equivalent required.
• Minimum 1 year of claims processing experience or BCBSKS Customer Service experience.
• Knowledge of NAIC OPL regulations and state laws helpful.

Responsabilidades

• Research and investigate claims to determine payment liability (OPL issues).
• Load notes/trailers from research on claims for accurate payment.
• Manage online claim maintenance and ensure proper system kick-outs for OPL investigations.

Conocimientos

Verbal communication

Written communication

Interpersonal skills

NAIC guidelines knowledge

State law knowledge

Educación

High school diploma or equivalent

Herramientas

Imaging

ACES

OTIS

MASK

Outlook

TROVE

CSI

Descripción del empleo

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 (