Claims Examiner II

🔥 6 minutes ago

🌾 Nebraska – Remote

🌾 Nebraska – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

👻 Ghost score 10%

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 and Blue Shield of Nebraska

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1939

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Blue Cross and Blue Shield of Nebraska is a prominent health insurance provider dedicated to serving the state of Nebraska. With over 80 years of experience, the company offers a range of health insurance plans, including group health, individual and family plans, Medicare, dental, and supplemental insurance options. Known for providing peace of mind, they are committed to ensuring member satisfaction and are recognized for their high-quality coverage and exceptional customer service. Blue Cross and Blue Shield of Nebraska also engages with the community through initiatives like the Nebraska Blue Foundation and emphasizes diversity, equity, and inclusion in its practices. The company is an independent licensee of the Blue Cross Blue Shield Association, providing trusted health coverage and resources to its members.

📋 Description

• Adjudicate healthcare claims using employer- and payer-specific policies and procedures • Review claims processing data against CMS and billing guidelines • Review medical claim attachments and documentation to determine medical appropriateness and benefit coverage • Review claim and line-item edits to determine appropriate payment • Forward claims to specialized internal and external resources when needed • Correspond with other departments to process claims • Meet performance metric scorecards and production and quality standards • Analyze complex claims for accuracy, completeness, benefits, eligibility, COB requirements, and provider status • Use multiple systems and screens to obtain and record claim information • Review claim disputes, including urgent internal department requests • Identify potential claim system or provider contract configuration issues and communicate them for correction • Provide feedback on quality trends and process improvement opportunities • Collaborate with teammates and business partners to achieve productivity and accuracy standards • Participate in special projects • Partner with less experienced associates to improve team and division knowledge and performance • Perform other duties assigned by Claims Leadership

🎯 Requirements

• High School degree • Proficiency as a Claims Examiner I or relevant healthcare experience • Excellent verbal and written communication skills • Proficiency with MS Office applications • Team collaborator • Must be able to work with minimal supervision • Creative thinker with good problem resolution skills related to healthcare claim adjudication • Strong work ethic with ability to multi-task when needed • Candidates applying to this remote position are required to live in the state of Nebraska or local Omaha metro area

🏖️ Benefits

• Comprehensive Total Rewards package • Equal Opportunity / Affirmative Action Employer • Disability accommodation support