Claims Processor II

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🔥 0 minutes ago

🐻 Alaska, Arizona, +25 more states – Remote

🐻 Alaska – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🌶️ New Mexico – Remote 🌲 North Carolina – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🏰 Missouri – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote ☕ Washington – Remote 🧀 Wisconsin – Remote

💵 $41.5k - $62.3k / year

⏰ Full Time

🟢 Junior

📋 Claims Specialist

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Premera Blue Cross

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1945

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Premera Blue Cross is an independent health insurance provider, serving businesses and residents of Washington State and Alaska as a licensee of the Blue Cross Blue Shield Association. The company offers a range of health plans including individual, family, employer-based, and Medicare Supplement plans. However, it has announced that it will exit the Medicare Advantage market as of January 1, 2025. Premera is committed to advancing health equity and community support, evident through its Social Impact Program focused on behavioral health and homelessness solutions in Washington and Alaska. Additionally, Premera complies with federal and state civil rights laws, offering language assistance services to ensure equitable care.

📋 Description

• Review, process, and resolve moderately complex claims in accordance with contracts and policies. • Research claims using reference materials and online tools. • Accurately code claims through the system. • Translate data into information acceptable to the claims processing system and follow up on pending claims. • Maintain claims files and perform follow-up on pending claims. • Prepare claims for return to providers or subscribers when additional information is needed. • Demonstrate adjudication proficiency to meet or exceed accuracy goals. • Meet cycle-time, productivity, accuracy, and quality goals. • Maintain confidentiality of documents and files. • Contact other carriers or provider offices as necessary. • Provide buddy training and feedback to new associates as needed. • Complete adjustments, reversals, and/or refunds as needed. • Apply quality practices to prevent defects and internal rework.

🎯 Requirements

• High School diploma or GED. (Required) • Six (6) months claims processing experience or customer service experience. (Required) • Experience with out-of-area program. (Preferred) • Technical experience of contract benefits, claims processing steps, and correction procedures. (Preferred) • Ability to exert up to 10 lbs. of force occasionally and/or a negligible amount of force frequently or constantly. • Ability to keyboard and communicate clearly and understandably in person and over the telephone.

🏖️ Benefits

• Medical, vision, and dental coverage with low employee premiums. • Voluntary benefit offerings, including pet insurance. • Life and disability insurance. • Retirement programs, including a 401K employer match and a pension plan vested after 3 years of service. • Wellness incentives and mental well-being resources, including counseling, stress management, and mindfulness programs. • Generous paid time off. • Tuition assistance for undergraduate and graduate degrees. • Employee recognition program. • Flexible on-campus routine and access to on-site resources, networking opportunities, and team engagement for hybrid employees. • Commuter perks. • Free convenient on-site parking. • Subsidized on-campus cafes. • Engaging on-site activities such as health and wellness events, coffee connects, and disaster preparedness fairs. • Fitness and well-being center with in-person and virtual workouts and nutritional counseling. • On-site recreation including shuffleboard and ping pong.