[Remote] Claims Processor I (Remote)

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

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