Claims Specialist

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Arkansas Blue Cross and Blue Shield

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1948

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Arkansas Blue Cross and Blue Shield is a health insurance provider licensed to offer health plans in all 75 counties of Arkansas. The company offers a wide range of insurance products including individual and family plans, Medicare and Medigap plans, dental and vision plans, as well as health plans for travelers and employer group plans. They provide members with personalized services such as health management through the Blueprint Portal, where users can manage their health plan, review claims, find healthcare providers, and estimate treatment costs. Arkansas Blue Cross and Blue Shield is an independent licensee of the Blue Cross and Blue Shield Association.

📋 Description

• Resolve medical claims that are not automatically adjudicated by the claims processing system • Investigate claims and communicate to obtain necessary information for claim completion • Enter claim data into the system • Review and interpret contract benefits • Conduct edit and audit resolution • Determine benefit eligibility • Identify and research processing issues using systems and manuals • Route claims to other areas • Consult internal staff and medical providers • Generate correspondence and complete forms • Complete initial, on-the-job, and continuing training • Access relevant computer systems and screens to process claims accurately • Stay current with changing processing procedures, benefits, and system modifications • Meet corporate and national MTM standards while maintaining departmental productivity and quality standards • Perform other duties as assigned • Maintain security and confidentiality of records and information • Adhere to segregation-of-duties guidelines

🎯 Requirements

• High School diploma or equivalent • Minimum two (2) years' college coursework (48 semester hours) or other equivalent certification with emphasis in anatomy, medical terminology, math, biology, or a related field, OR minimum one (1) year of related office experience such as claims processing, health insurance, or medical office • Must pass company proficiency test: Claims Assessment • Oral and written communication skills • Strong interpersonal skills • Sound judgment • Decision-making ability • Detail-oriented • Teamwork • Dependability • Clinical judgment • Computer work • Critical thinking • Customer service • Evaluating information • Organizing • Processing information • Reading comprehension • Researching • Time management • Ability to maintain security and confidentiality of records and information • Ability to adhere to segregation-of-duties guidelines

🏖️ Benefits

• Tuition reimbursement • Club Blue, a free, onsite gym • Green Leaf Grill and Green Leaf Grill Express, onsite restaurants promoting healthy eating • Incentives for wellness education and exercise • Inclusive culture and employee connection activities • Community volunteer opportunities