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Arkansas Blue Cross and Blue Shield · 12 hours ago

Claims Specialist I

United States

Full-time

Remote

Entry Level

1+ years exp

Arkansas Blue Cross and Blue Shield is a healthcare insurance provider seeking a Claims Specialist I. The role involves resolving medical claims that are not automatically adjudicated, ensuring timely and accurate processing according to divisional standards.

Financial ServicesHealth CareNon Profit

Responsibilities

Claims Processing: Claims processing involves the actions required to pay or deny pended claims (those which did not auto-adjudicate), including: entering data into the system; reviewing and interpreting contract benefits; conducting edit and audit resolution; determining benefit eligibility; Identifying and researching processing issues through systems and manuals; routing claims to other areas; consulting internal staff and medical providers; generating correspondence; and completing forms to obtain necessary information

Knowledge/Continuous Learning: In order to perform the actions required of the Claim Specialist job, the incumbent must undergo initial training, on-the-job training, and continuing education. Demonstrating knowledge of and possessing the ability to access all relevant computer systems and screens in order to process claims accurately; staying current with continually changing processing procedures, benefits, and system modifications; being knowledgeable of and able to meet corporate and national (MTM) standards while maintaining acceptable performance levels based on established departmental standards for productivity and quality; and showing familiarity with corporate and professional manuals and guidebooks, including the company processing manual and ICD, CPT, and HCPS codebooks

Other duties: As assigned

Qualification

Claims ProcessingMedical TerminologyCritical ThinkingCustomer ServiceOral CommunicationsWritten CommunicationsInterpersonal SkillsDetail-OrientedDecision Making

Required

High School diploma or equivalent

Minimum two (2) years' college coursework (48 semester hours) or other equivalent certification with an emphasis in anatomy, medical terminology, math, biology, or a related field

Minimum one (1) year of related office experience such as claims processing, health insurance, or medical office

Must pass company proficiency test: Claims Assessment

Oral & Written Communications

Strong Interpersonal skills

Sound Judgement

Decision Making

Detail-Oriented

Teamwork

Dependability

Clinical Judgment

Computer Work

Critical Thinking