Senior Claims Examiner II – Remote (NE/Omaha)

Blue Cross and Blue Shield of Nebraska; Oregon; Hybrid; USD 40,000 - 52,000; Full time

Benefits offered by this job

Total Rewards package

Job summary

Blue Cross and Blue Shield of Nebraska is seeking a Claims Examiner I for a remote role. You will analyze healthcare claims, review medical records, and determine benefits based on member contracts and CMS guidelines.

The position requires a high school degree and strong communication skills, with collaboration across departments to ensure accurate adjudication and timely processing. You'll use multiple systems to collect claim details, follow policies, and resolve complex claims.

Qualifications

• High School degree required.
• Experience as a Claims Examiner I or in healthcare claims preferred.
• Excellent verbal and written communication skills.
• Proficiency with MS Office applications.
• Team-oriented with ability to work with minimal supervision.
• Creative thinker with problem resolution skills for healthcare claim adjudication.
• Strong multi-tasking and prioritization abilities.

Responsibilities

• Analyze claims for accuracy and determine benefits per contracts, rules, eligibility, and COB requirements.
• Navigate multiple systems to obtain and record claim information.
• Follow applicable policies and procedures.
• Review medical records and authorization data to assess liability and coverage.
• Process claims within quality and production standards.
• Independently determine adjudication on complex claims.
• Review disputes submitted by members or providers and respond to urgent requests.
• Collaborate with teammates and other departments to meet productivity and accuracy goals.
• Contribute to quality trends and process improvements through feedback.

Skills

Verbal communication

Written communication

MS Office

Team collaboration

Independent work

Creative problem solving

Multi-tasking

Education

High School degree

Tools

MS Office

Job description

Blue Cross and Blue Shield of Nebraska is seeking a Claims Examiner I for a remote role. You will analyze healthcare claims, review medical records, and determine benefits based on member contracts and CMS guidelines.

The position requires a high school degree and strong communication skills, with collaboration across departments to ensure accurate adjudication and timely processing. You'll use multiple systems to collect claim details, follow policies, and resolve complex claims.