Claims Specialist

Job not on LinkedIn

🔥 8 minutes ago

⚜️ Louisiana – Remote

⚜️ Louisiana – Remote

⏰ Full Time

🟢 Junior

📋 Claims Specialist

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 12%

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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

• Accurately process claims edits • Determine primacy for Coordination of Benefits (COB) • Adjust previously paid claims • Initiate procedures to recover funds on overpaid claims • Review, research, and update claims, including benefit recalculations, claims edits, and refund requests • Apply contractual benefits and provider reimbursement rules • Maintain understanding of systems, applications, denial codes, edits, and processing codes • 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 and ensure notification letters are generated • Assist with training, implementations, documentation, and other assigned duties

🎯 Requirements

• High School Diploma or equivalent required • 6 months of experience in medical claims or health insurance-related customer service, or successful completion of BCBSLA adjustment or COB training • Certification in Medical Billing or Coding can be used in lieu of experience • Strong analytical ability • Oral and written communication skills • Human relations skills • Working knowledge of relevant PC software • Ability to comprehend, document, calculate, visualize, and analyze • Residency in or relocation to Louisiana is preferred for all positions • Successful background screening and pre-employment drug screening required • Individuals convicted of a felony involving dishonesty or breach of trust must obtain written consent from their state insurance commissioner to work in the insurance industry

🏖️ Benefits

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