Note: The job is a remote job and is open to candidates in USA. CareFirst BlueCross BlueShield is seeking a Claims Processor I to review and adjudicate paper/electronic claims under direct supervision. The role involves examining non-adjudicated claims, ensuring accurate processing according to policies, and collaborating with multiple departments to resolve issues.
Responsibilities
- Examines and resolves non-adjudicated claims to identify key elements of processing requirements based on contracts, policies and procedures
- Process product or system-specific claims to ensure timely payments are generated and calculate deductibles and maximums as well as research and resolve pending claims
- Completes research of procedures
- Applies training materials, correspondence and medical policies to ensure claims are processed accurately
- Partners with Quality team for clarity on procedures and/or difficult claims and receives coaching from leadership
- Required participation in ongoing developmental training to performing daily functions
- Completes productivity daily data that is used by leadership to compile performance statistics
- Reports are used by management to plan for scheduling, quality improvement initiatives, workflow design and financial planning, etc
- Collaborates with multiple departments providing feedback and resolving issues and answering basic processing questions
Skills
- High School Diploma or GED
- Less than one year experience processing claim documents
- Demonstrated analytical skills
- Demonstrated reading comprehension and ability to follow directions provided
- Basic written/oral communication skills
- Demonstrated ability to navigate computer applications
- 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
- Less than one year claims processing, billing, or medical terminology experience
Benefits
- Comprehensive benefits package
- Various incentive programs/plans
- 401k contribution programs/plans
Company Overview
CareFirst. It’s not just our name. It’s our promise. It was founded in 1934, and is headquartered in Baltimore, Maryland, USA, with a workforce of 5001-10000 employees. Its website is https://individual.carefirst.com.