Claims Analyst

Worldwide Insurance Services•King of Prussia, PA

6h•Hybrid

About The Position

At Blue Cross Blue Shield Global SolutionsSM (BCBS Global SolutionsSM), we make it easy for people and organizations to access and pay for healthcare abroad. By combining digital innovation with human-centered care, we go above and beyond for our customers and deliver an international healthcare experience that is simple, efficient, and human. Whether our customers live, work, travel, or study abroad, we give them the confidence and peace of mind to say yes to new possibilities. We are looking for a detail-oriented problem solver who enjoys analyzing information and ensuring healthcare claims are processed accurately and efficiently. The ideal candidate understands that behind every claim is a member seeking support and is committed to delivering quality outcomes that help members access the benefits they deserve. This role thrives in a fast-paced environment, requires effective communication and collaboration, and emphasizes ownership and continuous learning.

Requirements

High school diploma or equivalent
3+ years of health insurance claims processing, adjudication, or related experience
Experience reviewing medical claims and interpreting benefit plans
Strong analytical, organizational, and problem-solving skills
Comfortable making informed decisions and documenting claim determinations
Strong written and verbal communication skills
Ability to effectively manage multiple priorities while maintaining attention to detail
Proficient with Microsoft Office and comfortable learning new systems and technologies

Nice To Haves

Additional education
Experience processing international medical claims
Knowledge of BCBS Global Core or Federal Employee Program (FEP) claims
Familiarity with CPT, ICD-10, and medical coding practices
CPC, CCS, or other coding certifications
Experience with automated claims adjudication platforms
Health insurance industry expertise, particularly in international healthcare
Blue Cross Blue Shield experience

Responsibilities

Review and analyze international healthcare claims to determine services rendered, charges, and eligibility for payment
Investigate claim details and gather necessary information to ensure accurate adjudication and processing
Maintain complete and accurate claim documentation and records
Translate international medical invoices and supporting documentation when appropriate
Process claims according to benefit plans, policy provisions, and established claim handling procedures
Apply appropriate medical coding standards, including ICD-10, CPT, and Place of Service coding when required
Ensure accurate data entry and claim setup to facilitate proper claim adjudication and settlement
Process claims in accordance with specific program requirements, including Classic, BCBS Global Core, and FEP business lines
Meet departmental productivity, accuracy, and quality standards
Adhere to service level agreements and claim processing requirements
Identify trends, discrepancies, or issues that may impact claim outcomes
Escalate concerns and collaborate with leadership to resolve claim-related challenges
Partner with peers and cross-functional teams to support operational excellence
Stay current on policy updates, claim procedures, and industry regulations
Contribute ideas that improve efficiency, accuracy, and the overall member experience
Support special projects and additional responsibilities as assigned