Claims Processor IV

🔥 18 hours 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.

👻 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

• Accurately and timely review, research, and resolve moderate to highly complex claims according to contracts and policies. • Enter and process all assigned claims to completion. • Communicate across business units to resolve claims. • Identify procedural changes and assist with updating processes and procedures. • Provide specialized complex-claims knowledge to Care Facilitation, Customer Service, Appeals, benefit configuration, and other claims teams. • Complete accumulator adjustments, deductible credit loads, and member history reviews. • Reprocess carve-out claims, research claim history and contractual agreements, override designated claim edits, and complete reprocessing documentation. • Serve 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 aligned with corporate objectives. • Translate data into information acceptable to the claims processing system and follow up on pended claims. • Maintain confidentiality of documents and files. • Apply quality standards to prevent defects and internal rework.

🎯 Requirements

• High School diploma or GED (Required). • Two (2) years of 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. • Proven ability to audit other processors. • Understanding of Out-of-area programs. • Proficiency and/or experience in another functional area of Premera (M & B, CSR, PIMS, PS&S, or Sales). • Ability to keyboard and communicate clearly and understandably in person and over the telephone. • Ability to perform essential physical requirements with or without accommodation.

🏖️ 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. • Commuter perks. • Free convenient on-site parking. • Subsidized on-campus cafes. • On-site health and wellness activities. • 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.