Claims Specialist II

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🔥 9 minutes ago

⚜️ Louisiana – Remote

⚜️ Louisiana – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

📋 Claims Specialist

🚫👨‍🎓 No degree required

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Blue Cross and Blue Shield of Louisiana

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1934

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Blue Cross and Blue Shield of Louisiana is an independent licensee of the Blue Cross Blue Shield Association, offering a range of health insurance products and services in the state of Louisiana. The company provides health, dental, and travel insurance options, including Medicare Advantage plans such as HMO and PPO. They focus on delivering comprehensive healthcare coverage through various plans to meet varying customer needs, while partnering with doctors, hospitals, and clinics to ensure quality care and support. Additionally, the company emphasizes wellness programs, cost-saving opportunities, and accessibility for its members.

📋 Description

• Process claims edits accurately and determine primacy for Coordination of Benefits (COB) • Adjust previously paid claims and initiate recovery procedures for overpaid claims • Analyze, investigate, and resolve problem cases • Execute recovery processes and complete special projects • Review, research, and update claims, including benefit recalculations, claims edits, and refund requests • Maintain understanding of systems, applications, denial codes, edits, and processing codes to process coordinated and non-coordinated claims correctly • Request medical records when required • Communicate with internal and external contacts to establish accurate claim records • Review quality audits and correct or route them within 48 hours • Research and determine the correct order of benefits and correct COB records • Notify appropriate departments when Medicare determines primacy incorrectly • Review processed claims for payment consistency and maximize overpayment recovery • Recover funds from providers, subscribers, or beneficiaries when overpayments occur • Assist with training, implementations, and documentation • Perform other assigned duties and special projects

🎯 Requirements

• High School Diploma or equivalent required • 2 years in medical claims processing required • Coordination of Benefits (COB) processing experience preferred • Strong analytical ability, including logical, systemic, and investigative thinking • Strong oral and written communication skills • Strong human relations skills • Working knowledge of relevant PC software • Ability to prioritize multiple streams of work effectively • Ability to comprehend, document, calculate, visualize, and analyze • No licenses or certifications required • Must complete pre-employment drug screening • Subject to background and pre-employment checks after an offer • Louisiana residency or relocation is preferred

🏖️ Benefits

• Resources to live well and be healthy • Continued learning and skill development • Professional growth opportunities • Smoke- and tobacco-free workplace • Background and pre-employment drug screening after an offer • Reasonable accommodations for individuals with disabilities