Remote Medical Claims Specialist

Arkansas Blue Cross and Blue Shield; Arkansas; Remote; USD 28,000 - 34,000; Full time

Job summary

Arkansas Blue Cross and Blue Shield is seeking a Claims Specialist to resolve non-auto-adjudicated medical claims in a remote capacity. The role emphasizes timely, accurate processing aligned with divisional standards, with occasional impact from peak seasons and system downtime.

The ideal candidate will have a High School Diploma (or equivalent) plus college coursework or related office experience, strong communication, and organizational skills to handle detailed claim reviews and provider

Qualifications

• Must pass company proficiency test: Claims Assessment.
• Minimum two (2) years' college coursework (48 semester hours) or equivalent certification with emphasis in anatomy, medical terminology, math, biology, or related field.
• Or minimum one (1) year of related office experience such as claims processing, health insurance, or medical office.

Responsibilities

• Claims Processing: pay or deny pended claims (not auto-adjudicated) by entering data, reviewing contracts, and resolving edits.
• Knowledge/Continuous Learning: training, on-the-job learning, and continuing education to stay current with procedures and systems.
• Other duties: as assigned

Skills

Clinical Judgment

Computer Skills

Critical Thinking

Customer Service

Decision Making

Evaluating Information

Interpersonal Communication

Oral Communications

Organizing

Process Information

Reading Comprehension

Researching

Time Management

Education

High School Diploma

48 Semester Hours / related field

Job description

Arkansas Blue Cross and Blue Shield is seeking a Claims Specialist to resolve non-auto-adjudicated medical claims in a remote capacity. The role emphasizes timely, accurate processing aligned with divisional standards, with occasional impact from peak seasons and system downtime.

The ideal candidate will have a High School Diploma (or equivalent) plus college coursework or related office experience, strong communication, and organizational skills to handle detailed claim reviews and provider