Senior Claims Processor & Escalation Lead

Blue Shield of California; California; Ibrido; USD 36.000 - 50.000; Tempo pieno

Descrizione del lavoro

Blue Shield of California is seeking a Claims Processor, Specialist to ensure accurate and timely claims processing. The role reports to the Operations Manager and interfaces with departments and vendors, serving as the primary contact for priority claim cases. Hybrid virtual work with in-office needs based on business requirements.

The role emphasizes leadership development, mentorship, and contributing to high-performing teams while delivering results in a collaborative environment.

Competenze

• High School Diploma or GED or 1 year of additional relevant experience in lieu of a diploma required.
• 7 years of prior relevant experience required.
• Thorough knowledge of advanced health plan processing operations and procedures within Claims Processing with a deep understanding of end-to-end claims processing fundamentals required.
• Advanced-Expert skills creating documents/files using Excel, Outlook, Power Point, and Word required.

Mansioni

• Handle the most complex and escalated claims across all processing areas with full autonomy.
• Lead resolution of high-impact issues and serve as expert backup for all claim functions.
• Participate in projects, process improvements, and complex problem-solving initiatives.
• Mentor experienced staff and support training and knowledge transfer activities.
• Act as backup for supervisory coverage as needed.
• Other duties as assigned.

Conoscenze

Advanced Excel

Outlook

PowerPoint

Word

Formazione

High School Diploma or GED

Descrizione del lavoro

Blue Shield of California is seeking a Claims Processor, Specialist to ensure accurate and timely claims processing. The role reports to the Operations Manager and interfaces with departments and vendors, serving as the primary contact for priority claim cases. Hybrid virtual work with in-office needs based on business requirements.

The role emphasizes leadership development, mentorship, and contributing to high-performing teams while delivering results in a collaborative environment.