Claims Specialist

🔥 12 hours ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $41.6k - $66.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

👻 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 in accordance with contractual benefits and health care policies • Manage daily work queues, quality of claims processed, and final resolution • Monitor claim turnaround times to meet compliance guidelines and performance guarantees • Process, adjust, or update moderate to complex claims payments and payment errors • Respond to inquiries regarding claims payments from customer service professionals, subscribers, providers, physicians, and other insurance carriers • Meet or exceed established quality and performance standards • Determine suspended claim resolution methods by reviewing benefit eligibility, claims history, and other information • Escalate claims requiring specialized resolution to subject matter experts • Identify system issues, recommend potential solutions, and refer issues to technical staff • Work with Provider Services specialists to deliver tailored provider services • Review claims for possible fraud and abuse and send them to the Special Investigations Unit • Drive efficiency and production gains through continuous improvement and claims knowledge • Coordinate with other insurance carriers and Medicare to determine BCBSNC payment liability • Represent Claims interests on divisional or enterprise project teams

🎯 Requirements

• High school diploma or GED • 3+ years of experience in related field • At this time, Blue Cross NC will not sponsor employment authorization for this position • Health insurance claims experience (bonus point) • Facets claims experience (bonus point)

🏖️ 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 • 401k match including an annual company contribution • Paid Time Off (PTO) • Annual Incentive Bonus • Work-life balance, flexibility, and autonomy • Remote work with a few in-office visits each year for meaningful moments