Claim/Pend Specialist

Horizon Blue Cross Blue Shield of New Jersey•Hopewell, NJ

2d•Onsite

About The Position

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds. About the Role This position is responsible for initial claim pending resolution and claim adjustments. In addition this position is responsible for the initial examining, coding, and input of claims and referrals into the various processing systems.

Requirements

High School Diploma or equivalent required
Requires one (1) year of clerical business experience
Must be proficient with the use of personal computers and supporting software in a Windows based environment, including MS Office products.
Should be knowledgeable in the use of intranet and internet applications; including ability to navigate.
Strong typing, data entry and keyboarding necessary.
Must be proficient using a calculator for simple math calculations.
Must be detail oriented with good organizational and data processing skills.
Proven ability to follow detailed instructions is essential.
Must demonstrate ability to learn quickly and apply learning to new situations.
Must exhibit flexibility to change as appropriate.

Nice To Haves

Medical Terminology/Billing/Coding experience preferred
Experience in a Production and Quality driven work environment preferred

Responsibilities

Resolve edits on claims (pending resolution) and may require claim adjustments.
Data entry of primary and secondary claims, as well as referrals into various processing systems.
Return claims with unidentifiable information back to healthcare professional/subscriber with letter requesting additional information.
Perform general clerical duties to ensure accurate disposition of claims/referrals that cannot be entered into the various processing systems.
Perform other related duties as required by Management.