OPL Claims Investigator — Remote

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

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.