Claims Processor I (Remote)

Resp & Qualifications

PURPOSE:
Under direct supervision, reviews and adjudicates paper/electronic claims. Determines proper handling and adjudication of claims following organizational policies and procedures.

ESSENTIAL FUNCTIONS:

• 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. The Claims Processor also use automated system processes to send pending claims to ensure accurate completion according to medical policy, contracts, policies and procedures allowing timely considerations to be generated using multiple systems.

• 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.

QUALIFICATIONS:

Education Level: High School Diploma or GED.

Experience: Less than one year experience processing claim documents.

Preferred Qualifications: Less than one year claims processing, billing, or medical terminology experience.

Knowledge, Skills and Abilities (KSAs)
Demonstrated analytical skills.
Demonstrated reading comprehension and ability to follow directions provided.
Basic written/oral communication skills.
Demonstrated ability to navigate computer applications.

Salary Range: $30,600 - $56,100

Salary Range Disclaimer

Salary will be based on education, location, experience, certifications, etc. In addition to your salary, CareFirst offers benefits such as a comprehensive benefits package, incentive and recognition programs, and 401k contribution (all benefits are subject to eligibility requirements).

Department

Department:FACETS Medical Claims

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

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

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