Claims Specialist

Job not on LinkedIn

🔥 6 minutes ago

🐻 Alaska, California, +2 more states – Remote

🐻 Alaska – Remote 🏄 California – Remote 🌺 Hawaii – Remote 🗽 New York – Remote

💵 $42.2k - $79.3k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

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👻 Ghost score 0%

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Health Care Service Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Health Care Service Corporation is an independent licensee of the Blue Cross Blue Shield Association, serving nearly 23 million people across the United States with a wide range of health benefit solutions. The company provides health coverage options for various groups, including employers, individuals, families, as well as Medicare and Medicaid plans. In addition to health insurance, HCSC offers services such as pharmacy solutions, life and dental insurance, and health data technology. With nearly a century of experience, HCSC is dedicated to improving access to quality care, enhancing health outcomes, and reducing costs while maintaining a deep commitment to its members and local communities.

📋 Description

• Process and examine medical, disability, and/or life insurance claims • Apply specialized claims-processing knowledge and code-review edits • Identify fraud and abuse patterns • Apply PPO reimbursement methodologies and understand stop loss coverage • Investigate claims and make informed decisions • Maintain accurate, detailed records and thoroughly document claim information • Organize workflow, prioritize numerous tasks, and follow up on responsibilities • Support other team members and collaborate with employees, providers, clients, and other departments • Meet prescribed deadlines and work effectively in a fast-paced, customer-service-driven environment • Adapt to new systems, policies, environments, and process-improvement methodologies

🎯 Requirements

• 4 years medical claims processing experience • Comprehensive knowledge of specialized medical claims processing • Understanding of code review edits, fraud and abuse patterns, PPO reimbursement methodologies, and stop loss coverage • Excellent verbal and written communication skills • Excellent interpersonal skills • Performance and audit scores of 99% payment, 97% financial, and 97% accuracy or better • Microsoft Office proficiency • Strong organization and attention to detail • Ability to work effectively with team members, employees, providers, and clients • Ability to work in a fast-paced, customer service-driven environment • Strong disability and/or life claim knowledge • Understanding of all aspects of claims examining • Solid investigation, analytical, organizational, math, and decision-making skills • Minimum 5 years insurance claim experience with understanding of medical terminology • Ability to maintain accurate, detailed records and thoroughly document claim information • Creative problem-solving and conflict-resolution skills • Ability to organize workflow and accept additional tasks and projects • Strong time management skills • Self-starter able to prioritize, manage, and follow up on numerous tasks • Ability to make decisions independently or with minimal supervision • Ability to handle pressure, interact effectively with other departments, and meet deadlines • Ability to foster a positive team environment • Adaptability to new systems, policies, environments, and improvement methodologies • Effective use of personal computers and related software • Proficiency in Word, Excel, and Outlook; Access preferred • Preferred employment with HB as a Medical Claims Analyst and then Sr. Claims Analyst • Four-year college degree in medical and/or business field preferred/a plus

🏖️ Benefits

• Health and wellness benefits • 401(k) savings plan • Pension plan • Paid time off • Paid parental leave • Disability insurance • Supplemental life insurance • Employee assistance program • Paid holidays • Tuition reimbursement • Other incentives • Annual incentive bonus plan subject to the terms and conditions of the plan