Remote Claims Examiner I–IV: Process & Resolve Claims

Excellus BCBS; City of Albany (NY); Vor Ort; USD 28.000 - 45.000; Vollzeit

Zusammenfassung

Excellus BCBS is seeking a Claims Examiner to perform entry, adjudication and adjustment of a wide range of claims while following MTM, NCQA and corporate policies. The role emphasizes accuracy, privacy, and strong collaboration with internal teams to ensure timely resolution.

Levels I–IV describe increasing complexity, from front-end eligibility tasks to high-profile adjustments. A valid NYS Independent Adjuster license and ongoing license maintenance are required.

Qualifikationen

• High School diploma or equivalent required.
• Experience in claims processing or customer service preferred.
• Must have NYS Independent Adjuster License with renewals maintained.

Aufgaben

• Handle claims processing including entry, adjudication and adjustment.
• Identify trends and communicate risk to leadership.
• Collaborate with internal departments to resolve claims.
• Maintain privacy and adhere to policies.
• Provide support and training to peers as needed.

Kenntnisse

Customer service

Claims processing

Multi-tasking

Attention to detail

Communication

Ausbildung

High School diploma or equivalent

NYS Independent Adjuster License

Tools

Windows environment

Jobbeschreibung

Excellus BCBS is seeking a Claims Examiner to perform entry, adjudication and adjustment of a wide range of claims while following MTM, NCQA and corporate policies. The role emphasizes accuracy, privacy, and strong collaboration with internal teams to ensure timely resolution.

Levels I–IV describe increasing complexity, from front-end eligibility tasks to high-profile adjustments. A valid NYS Independent Adjuster license and ongoing license maintenance are required.