Claims Specialist III

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🔥 10 minutes ago

⚜️ Louisiana – Remote

⚜️ Louisiana – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

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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

• Accurate processing of claims edits • Determining primacy for the Coordination of Benefits (COB) • Adjusting previously paid claims and initiating recovery procedures • Analyzing, investigating, and resolving problem cases • Assisting with developing, documenting, and testing system changes • Providing direct support for Customer Service for complex issues • Responsible for accurate and timely processing of complex regular adjustment requests • Ensuring compliance with laws and regulations

🎯 Requirements

• High School Diploma or equivalent required • 4 years of experience in Coordinator of Benefits (COB) or adjustments/refunds processing required • Self-funded processing experience preferred • Strong analytical ability • Excellent oral and written communication skills • Working knowledge of relevant PC software • Full understanding of claims procedures, primacy rules, and claims processing guidelines • Strong background in claims coding, processing, edits, and adjusting payments • Ability to prioritize multiple streams of work effectively

🏖️ Benefits

• Health insurance • Retirement plans • Paid time off • Professional development opportunities