Remote OPL Claims Investigator

Blue Cross & Blue Shield of Kansas, Inc.; Topeka (KS); A distancia; USD 30.000 - 37.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Health/Vision/Dental insurance

6 weeks paid parental leave

Tuition reimbursement

401(k) plan matching up to 5%

Descripción de la vacante

Blue Cross & Blue Shield of Kansas is seeking an OPL Claims Correspondent in Topeka. You will investigate complex claims involving overlapping coverage and subrogation, coordinate adjustments, and ensure accurate claim resolution. Remote work eligibility applies within policy guidelines.

You will research OPL cases, load relevant notes, and maintain meticulous records for audits. Strong communication, knowledge of NAIC guidelines, and claims systems proficiency are essential for success.

Formación

• High school diploma or equivalent required.
• Minimum 1 year claims processing experience or BCBSKS customer service experience required.
• Knowledge of NAIC OPL regulations and Kansas laws preferred.

Responsabilidades

• Research and investigate claims to determine payment liability (OPL).
• Load notes/trailers from research on claims based on information from insureds, providers and outside vendors.
• Maintain detailed and accurate records of all claims researched for audits or reviews.
• Initiate calls to outside entities to obtain eligibility information or clarify OPL circumstances.
• Remain current on state law, contracts and policy related to auto no-fault and subrogation.

Conocimientos

Verbal communication

Written communication

Customer service experience

Claims processing

Educación

High school diploma or equivalent

Herramientas

Imaging system

ACES

OTIS

MASK

Outlook

TROVE

Descripción del empleo

Blue Cross & Blue Shield of Kansas is seeking an OPL Claims Correspondent in Topeka. You will investigate complex claims involving overlapping coverage and subrogation, coordinate adjustments, and ensure accurate claim resolution. Remote work eligibility applies within policy guidelines.

You will research OPL cases, load relevant notes, and maintain meticulous records for audits. Strong communication, knowledge of NAIC guidelines, and claims systems proficiency are essential for success.