Claims Representative

🔥 15 hours ago

🌲 North Carolina, South Carolina, +1 more states – Remote

🌲 North Carolina – Remote 🌴 South Carolina – Remote ⚔️ Virginia – Remote

💵 $41.6k - $66.6k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

📋 Claims Specialist

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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.

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Blue Cross NC

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 1933

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Blue Cross NC is a health insurance provider that offers a range of health plans and services to individuals and groups. The company focuses on delivering quality healthcare coverage and improving health outcomes for its members through innovative health programs and services. Blue Cross NC is committed to enhancing access to affordable healthcare while supporting the health and wellness of the communities it serves.

📋 Description

• Review and timely adjudicate claims • Administer claims according to contractual benefits and health care policies • Manage daily work queues and the quality of claims processed • Ensure final resolution of claims • Monitor claim turnaround times to meet compliance guidelines and performance guarantees • Process, adjust, or update routine claims payments and payment errors • Respond to inquiries from Core Service, subscribers, providers, physicians, and other insurance carriers regarding claims payments • Determine suspended claim resolution methods by reviewing benefit eligibility, claims history, and other information • Identify system problems, document issues, recommend potential solutions, refer issues to technical staff, and follow up on resolution • Identify and analyze opportunities to improve BCBSNC processes, policies, and services • Coordinate with other insurance carriers and Medicare to determine BCBSNC payment liability • Review claims for possible fraud and abuse and refer them to the Special Investigations Unit

🎯 Requirements

• High school diploma or GED • 0-2 years of experience in related field • Data entry experience is a plus • Knowledge of claims adjudication, claims analysis, claims management, claims processing, claims resolution, claims review, insurance claims, medical claims processing, Medicare, policy knowledge, and process improvements • Customer service skills • Documentation skills

🏖️ Benefits

• Medical, dental, and vision coverage • Health and wellness programs • Parental leave and support • Adoption and surrogacy assistance • Career development programs • Tuition reimbursement for continued education • 401(k) match including an annual company contribution • Paid Time Off (PTO) • Annual Incentive Bonus • Flexible work arrangements • Remote work with a few in-office visits each year for Remote Flex roles