Claims Specialist

Job not on LinkedIn

🔥 0 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%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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 • Determine primacy for Coordination of Benefits (COB) • Adjust previously paid claims • Initiate procedures to recover funds from overpaid claims • Review, research, and update claims, including recalculation of benefits, claims edits, and refund requests • Apply contractual benefits and provider reimbursement rules • Identify 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 maintain accurate claim records • Review quality audits and correct or route them within 48 hours • Research and determine the correct order of benefits and make COB record corrections • Communicate Medicare primacy discrepancies to the appropriate department and ensure notification letters are generated • Assist with training, implementations, documentation, and other assigned duties • Report to the Supervisor, Claims Operations • Collaborate with internal departments, providers, members, lawyers, groups, insurers, and other plans

🎯 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 • Must be authorized to work for Louisiana Blue in the United States without employer-sponsored immigration support • Must not require current or future employment-based immigration sponsorship or employer support • Must complete pre-employment drug screening with satisfactory results • Felony convictions involving dishonesty or breach of trust require written consent from the state insurance commissioner to work in the insurance industry

🏖️ Benefits

• Resources to live well and be healthy • Learning and professional development opportunities • Skills development and professional growth • Opportunities to serve local communities • Reasonable accommodations for individuals with disabilities • Smoke- and tobacco-free workplace • Background and pre-employment drug screening • Drug-free workplace