Claims Processor IV

🔥 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

💵 $48.4k - $72.6k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

📋 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

• Enter and process all assigned claims to completion • Review, research, and resolve moderate to highly complex claims accurately and timely • Reprocess claims, including organ transplants, SCCA, BDCT, benefit exchanges, and large-dollar hospital claims • Communicate across business units including Configuration, Customer Service, and Marketing Liaisons to resolve claims • Identify procedural changes and assist with updating processes and procedures • Provide specialized complex-claims processing knowledge to Care Facilitation, Customer Service, Appeals, benefit configuration, and claims teams • Complete accumulator adjustments, deductible credit loads, and member history reviews • Reprocess carve-out claims and complete related documentation • Act as team subject matter expert by training and auditing claims and providing feedback and coaching • Complete specialized projects such as auditing, procedure updates, and coordination with configuration • Meet cycle time and productivity goals • Translate data into information acceptable to the claims processing system and follow up on pending claims • Maintain confidentiality and apply quality standards to prevent defects and rework

🎯 Requirements

• High School diploma or GED (Required) • Two (2) years claims processing experience in medical and/or dental plans, or 2 years prior medical and/or dental office/insurance industry experience (Required) • Detailed processing knowledge on Premera processing systems (Preferred) • Proven ability to audit other processors (Preferred) • Understanding of Out-of-area programs (Preferred) • Ability to exert up to 10 lbs. of force occasionally and/or a negligible amount of force frequently or constantly • Ability to keyboard • Ability to communicate clearly and understandably in person and over the telephone • Must maintain confidentiality of documents/files

🏖️ Benefits

• Medical, vision, and dental coverage with low employee premiums • Voluntary benefit offerings, including pet insurance • Life and disability insurance • 401K employer match • 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 • Commuter perks • Free convenient on-site parking • Subsidized on-campus cafes • On-site health and wellness activities • Fitness & well-being center with in-person and virtual workouts and nutritional counseling • Shuffleboard and ping pong on campus