Claims Specialist

🔥 0 minutes ago

🥔 Idaho, North Dakota, +3 more states – Remote

🥔 Idaho – Remote 🌾 North Dakota – Remote 🌲 Oregon – Remote ⛷️ Utah – Remote ☕ Washington – Remote

💵 $19 - $25 / hour

⏰ Full Time

🟢 Junior

📋 Claims Specialist

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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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 in a timely and accurate manner according to divisional quality and productivity standards. • Investigate claims and communicate to obtain necessary information to complete claims. • Enter data into the claims system. • Review and interpret contract benefits. • Conduct edit and audit resolution. • Determine benefit eligibility. • Identify and research processing issues through systems and manuals. • Route claims to other areas. • Consult internal staff and medical providers. • Generate correspondence and complete forms to obtain necessary information. • Complete initial training, on-the-job training, and continuing education. • 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 levels. • Use corporate and professional manuals and guidebooks, including the company processing manual and ICD, CPT, and HCPS codebooks. • Perform other duties as assigned.

🎯 Requirements

• High School diploma or equivalent. • Minimum two (2) years' college coursework (48 semester hours) or other equivalent certification with an 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 & Written Communications. • Strong Interpersonal skills. • Sound Judgement. • Decision Making. • Detail-Oriented. • Teamwork. • Dependability. • Must ensure the security and confidentiality of records and information. • Must adhere to segregation of duties guidelines in the Administrative Manual.