Remote Medical Claims Specialist – Detail‑Oriented Resolutions

Arkansas Blue Cross Blue Shield; United States; Remote; USD 27,000 - 35,000; Full time

Job summary

Arkansas Blue Cross Blue Shield is seeking a remote Claims Specialist to resolve non-auto adjudicated medical claims promptly and accurately, following divisional standards. The role involves data entry, benefits interpretation, and researching issues with system tools and manuals.

You’ll communicate with providers and internal staff to obtain necessary information and ensure timely claim resolution. This regular, remote position emphasizes attention to detail, strong communication, and the

Qualifications

• High School diploma or equivalent.
• 2 years college coursework (48 semester hours) or 1 year related office experience.
• Must pass Claims Assessment proficiency test.

Responsibilities

• Claims Processing: pay or deny pended claims (not auto-adjudicated); enter data; review contracts; resolve edits and audits; determine eligibility; research issues via systems/manuals; route claims; consult providers; generate correspondence; complete forms.
• Knowledge/Continuous Learning: undergo initial/on-the-job/continuing education; access all relevant computer systems; stay current with procedures, benefits, and system changes; follow MTM standards while maintaining performance.
• Other duties: As assigned

Skills

Oral & Written Communications

Strong Interpersonal skills

Sound Judgement

Decision Making

Detail-Oriented

Teamwork

Dependability

Clinical Judgment

Computer Work

Critical Thinking

Customer Service

Evaluating Information

Interpersonal Communication

Oral Communications

Organizing

Process Information

Reading Comprehension

Researching

Time Management

Education

High School diploma or equivalent

Job description

Arkansas Blue Cross Blue Shield is seeking a remote Claims Specialist to resolve non-auto adjudicated medical claims promptly and accurately, following divisional standards. The role involves data entry, benefits interpretation, and researching issues with system tools and manuals.

You’ll communicate with providers and internal staff to obtain necessary information and ensure timely claim resolution. This regular, remote position emphasizes attention to detail, strong communication, and the