Claims Examiner

Job not on LinkedIn

🔥 0 minutes ago

🌪️ Kansas, Missouri – Remote

🌪️ Kansas – Remote 🏰 Missouri – Remote

💵 $20 - $26 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

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👻 Ghost score 0%

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Blue Cross and Blue Shield of Kansas

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

Healthcare • Consulting • Healthcare Insurance

Blue Cross and Blue Shield of Kansas is the largest health insurer in the state of Kansas and operates as a mutual insurance company owned by its policyholders. Governed by a board consisting of 16 Kansans with diverse expertise, the company ensures that the voices of customers and healthcare professionals are included in its operations. With a strong financial foundation, BCBSKS pays over $1 billion in annual claims to healthcare providers and actively contributes more than $140 million to the local economy through payroll and taxes. Headquartered in Topeka, KS, it employs nearly 1,400 individuals across various locations in the state and is part of the Blue Cross Blue Shield Association, which facilitates collaboration among 36 independent Plans nationwide.

📋 Description

• Review, analyze, and verify healthcare claims submitted by policyholders or medical providers • Ensure documentation, ICD-10, CPT, HCPCS coding, and data are complete and accurate • Check eligibility, coverage, and applicable benefits according to policy terms • Enter and process claims information accurately in the system • Apply deductibles, co-pays, co-insurance, and maximum coverage limits • Approve or deny claims based on policy coverage and regulatory/company standards • Adjust processed claims for corrective action • Correspond with healthcare providers, patients, and internal departments to resolve discrepancies • Investigate and resolve complex or escalated claim issues • Ensure compliance with state and federal healthcare regulations • Maintain accurate claims records for audits and reviews • Meet individual and team performance targets for speed, accuracy, and quality • Participate in ongoing training on policy and technology changes • Monitor and work daily reports to ensure timely claim control • Perform other assigned duties

🎯 Requirements

• High school diploma or equivalent required • Reside in Kansas or Missouri, or be willing to relocate as a condition of employment • Previous experience in healthcare claims processing, medical billing, medical terminology, or health insurance preferred • Knowledge of medical claim processing, medical terminology, insurance policies, and coding standards (ICD, CPT) • Strong attention to detail and organizational skills • Excellent written and verbal communication skills • Ability to work efficiently under pressure and meet deadlines • Critical thinking and problem-solving skills • Office and/or computer system experience preferred • Subject to pre-employment drug screening, criminal conviction check, employment verifications, and education verification

🏖️ Benefits

• Paid vacation and sick leave • Paid maternity and paternity leave available immediately upon hire • Incentive pay program (EPIP) • Health, vision, and dental insurance • 6 weeks paid parental leave for new mothers and fathers • Fertility/adoption assistance • 2 weeks paid caregiver leave • 401(k) plan matching up to 5% • Tuition reimbursement • Health and fitness benefits, discounts and resources • Ongoing training and development programs • Flexible work environment • Equal employment opportunities