Senior Claims Examiner II — Remote (Nebraska)

Nebraska Blue; Nebraska; Remote; USD 42,000 - 56,000; Full time

Job summary

Blue Cross and Blue Shield of Nebraska is seeking a Claims Examiner II for a remote, Nebraska-based role. You will interpret claim adjudication rules, analyze complex claims, and determine benefits based on member contracts and CMS guidelines.

Daily responsibilities include reviewing medical records, ensuring accuracy, and maintaining production and quality targets. The role requires strong communication, teamwork, and experience in healthcare claim adjudication, with a focus on collaboration

Qualifications

• Excellent verbal and written communication skills.
• Proficiency with MS Office applications.
• Proficiency as a Claims Examiner I or relevant healthcare experience.
• Team collaborator with ability to work with minimal supervision.

Responsibilities

• Analyze claims for accuracy and completeness to determine benefits based on member contracts, eligibility, and COB requirements.
• Process claims within quality and production standards and review adjudication edits for payment decisions.
• Review medical record documentation and authorization information to determine liability and coverage.
• Communicate issues for research and correction and assist other lines of business as needed.

Skills

Communication skills

Team collaboration

Healthcare claim adjudication

Multi-tasking

Education

High School degree

Tools

MS Office

Job description

Blue Cross and Blue Shield of Nebraska is seeking a Claims Examiner II for a remote, Nebraska-based role. You will interpret claim adjudication rules, analyze complex claims, and determine benefits based on member contracts and CMS guidelines.

Daily responsibilities include reviewing medical records, ensuring accuracy, and maintaining production and quality targets. The role requires strong communication, teamwork, and experience in healthcare claim adjudication, with a focus on collaboration