Remote Medical Claims Specialist I

Arkansas Blue Cross and Blue Shield; Arkansas; Hybrid; USD 52,000 - 70,000; Full time

Job summary

Arkansas Blue Cross and Blue Shield seeks a Claims Specialist to resolve non-auto-adjudicated medical claims with precision. You will review contracts, determine benefits, and communicate with providers to obtain missing information.

The role supports timely, compliant processing in a remote work setting across several states. Candidates should have a high school diploma, 1–2 years of related office experience, and strong communication skills.

Qualifications

• Requires high school diploma or equivalent.
• Minimum 48 semester hours or related coursework in anatomy/medical terminology/math/biology or related field or 1 year of related office experience.
• Must pass proficiency test: Claims Assessment.

Responsibilities

• Resolve non-auto-adjudicated claims promptly and accurately.
• Review contracts, determine benefit eligibility, and research processing issues.
• Maintain knowledge of processing procedures, systems, and codebooks.

Skills

Oral communications

Written communications

Interpersonal skills

Detail oriented

Teamwork

Dependability

Critical thinking

Time management

Reading comprehension

Organizing

Process information

Evaluating information

Customer service

Clinical judgment

Education

High School diploma

48 semester hours or related coursework

Related office experience (claims processing/health insurance)

Tools

ICD codes

CPT codes

HCPCS codebooks

Job description

Arkansas Blue Cross and Blue Shield seeks a Claims Specialist to resolve non-auto-adjudicated medical claims with precision. You will review contracts, determine benefits, and communicate with providers to obtain missing information.

The role supports timely, compliant processing in a remote work setting across several states. Candidates should have a high school diploma, 1–2 years of related office experience, and strong communication skills.