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CareFirst BlueCross BlueShield · 11 hours ago

Claims Adjuster I (Remote)

United States

Full-time

Remote

Mid Level

$36K/yr - $66K/yr

3+ years exp

CareFirst BlueCross BlueShield is seeking a Claims Adjuster I to investigate and adjust claims according to established procedures. The role involves verifying insurance claims, updating audit records, and settling claims through payment or denial while ensuring compliance with authority limits.

Health CareNon ProfitService Industry

No H1B

Responsibilities

Proactively investigate and perform adjustments of claims. Ensure claims are handled within authority limits, and in line with standard procedures and guidelines

Updates claims audit records by entering, verifying, and securing data

Settle standard/complex claims through payment or denial

Provides claims audit information and reports by collecting, analyzing, and summarizing data and trends

Improves claims adjustment job knowledge by attending training sessions

Qualification

Claims experienceData analysisAttention to detailCommunicationProblem-solving

Required

High School Diploma or GED

3 years' claims experience and complete understanding of all systems, policies and procedures

Ability to analyze information gathered from investigation

Excellent communication skills both written and verbal

Ability to recognize, analyze, and solve a variety of problems

Skill in completing assignments accurately with attention to detail

Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence

Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging

Must be eligible to work in the U.S. without Sponsorship