Claims Processor III

🔥 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

💵 $44.8k - $67.2k / year

⏰ Full Time

🟢 Junior

📋 Claims Specialist

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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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, research, and resolve moderate to complex dental, medical, and hospital claims using contracts, policies, reference materials, and online tools. • Identify, research, and resolve coordination of benefits, subrogation, and general inquiry issues and communicate results. • Complete claim adjustments, reversals, and/or refunds. • Serve as the team technical subject matter expert. • Train and audit trainee claims and provide feedback and technical support. • Keep reference materials updated. • Build and maintain relationships with internal and external customers through written and verbal communication. • Make outbound calls and receive inbound calls. • Prepare formal history reviews. • Meet cycle time and productivity goals aligned with corporate objectives. • Maintain confidentiality of documents and files. • Translate data into information acceptable to the claims processing system and follow up on pended claims. • Apply first-time-quality practices to prevent defects and internal rework. • Perform other duties or special projects as assigned.

🎯 Requirements

• High School diploma or GED (Required). • One (1) year of claims processing experience or customer service experience (Required). • Understanding of Out-of-area programs. • In-team focused audit experience. • Ability to review, research, and resolve moderate to complex claims in accordance with contracts and policies. • Ability to interpret procedures and policies for accurate claims resolution. • Written and verbal communication skills. • Ability to maintain confidentiality of documents and files. • Ability to meet cycle time and productivity goals. • Eligible to work in one of the listed hiring states: Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, or Wisconsin.

🏖️ 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, including mental well-being resources, counseling services, stress management programs, and mindfulness programs. • Generous paid time off. • Tuition assistance for undergraduate and graduate degrees. • Employee recognition program. • Commuter perks. • Free convenient on-site parking. • Subsidized on-campus cafes. • On-site activities such as health and wellness events, coffee connects, disaster preparedness fairs, and more. • Fitness and well-being center with in-person and virtual workouts and nutritional counseling. • Flexible on-campus routine for hybrid employees, with access to on-site resources, networking opportunities, and team engagement.