Remote Medical Claims Specialist - Benefits & Resolutions

Arkansas Blue Cross and Blue Shield; United States; Remote; USD 42,000 - 64,000; Full time

Job summary

Arkansas Blue Cross and Blue Shield is seeking a claims processor to own the resolution of pended medical claims through data entry, benefit interpretation, and edit audits.

You will research processing issues, consult internal staff and providers, and route claims to the appropriate areas, generating correspondence and completing forms as needed.

This remote role supports a work-from-home setup across several states, with a culture that emphasizes wellness and long-tenured employees.

Qualifications

• Complete initial and ongoing training to stay current with processing procedures, benefits, and system changes.
• Use clinical judgment, critical thinking, and strong communication to make sound decisions.
• Meet departmental quality and productivity standards while maintaining confidentiality.

Responsibilities

• Own the resolution of pended medical claims through data entry, benefit interpretation, and edit audits.
• Research processing issues, consult internal staff and providers, and route claims to appropriate areas.
• Generate correspondence and complete forms to obtain necessary information.

Skills

Data entry

Clinical judgment

Communication

Job description

Arkansas Blue Cross and Blue Shield is seeking a claims processor to own the resolution of pended medical claims through data entry, benefit interpretation, and edit audits.

You will research processing issues, consult internal staff and providers, and route claims to the appropriate areas, generating correspondence and completing forms as needed.

This remote role supports a work-from-home setup across several states, with a culture that emphasizes wellness and long-tenured employees.