Remote Claims Specialist: Resolve Pended Claims

Arkansas Blue Cross and Blue Shield; Little Rock (AR); Remote; USD 27,000 - 35,000; Full time

Job summary

Arkansas Blue Cross and Blue Shield is seeking a Claims Specialist to resolve medical claims not automatically adjudicated by the system, ensuring timely and accurate resolution. The role involves additional investigation, communications with providers, and adherence to divisional quality standards.

The position is 100% remote with preference for Arkansas residents. Applicants must have a high school diploma or equivalent, and either two years of college coursework or one year of related office

Qualifications

• High school diploma or equivalent required.
• Two years of college coursework (48 semester hours) or related certification preferred in anatomy, medical terminology, math, biology, or related field.
• Must pass Claims Assessment proficiency test.

Responsibilities

• Process and adjudicate pended claims, enter data into the system and review contracts benefits.
• Identify and resolve processing issues through systems and manuals; route claims to appropriate areas and generate required documentation.
• Maintain knowledge of processing procedures, standards, and codebooks; participate in ongoing training and education.

Skills

Oral & Written Communications

Interpersonal Skills

Sound Judgement

Decision Making

Detail-Oriented

Teamwork

Dependability

Time Management

Education

High School diploma or equivalent

Two years college coursework (48 semester hours) or related certification

Tools

ICD/CPT/HCPCS codebooks

Job description

Arkansas Blue Cross and Blue Shield is seeking a Claims Specialist to resolve medical claims not automatically adjudicated by the system, ensuring timely and accurate resolution. The role involves additional investigation, communications with providers, and adherence to divisional quality standards.

The position is 100% remote with preference for Arkansas residents. Applicants must have a high school diploma or equivalent, and either two years of college coursework or one year of related office