Claims Examiner I

Blue Cross Blue Shield • Kansas City, MO

244d

About The Position

Under general supervision, assesses claim information, references contracts and performs calculations and other functions to accomplish the processing and payment of insurance claims of a complicated or non-routine nature. Interprets contract information and communicates with outside parties to obtain information and coordinate coverage. Performs claim research and adjustments.

Requirements

• High school diploma or general education degree (GED).
• 2 years of previous customer service, member services, or claims processing experience; or any combination of required education and experience.
• Advanced Keyboarding Knowledge.
• Intermediate knowledge of Microsoft Office.

Nice To Haves

• Knowledge of FACETS and/or other computerized claims processing system as applicable (FEP).
• Associates degree from college or technical school.

Responsibilities

• Successfully completes all training programs as required for the level.
• Processes claims for two products or claim types (dental, hospital, medical, ITS, FEP).
• Performs research and adjustment functions for claims.
• Perform special projects (e.g., complex accumulator reconsiderations, New Directions).
• Responds to written inquiries from internal and external customers as business needs dictate.
• Sets up deducts, CLOV table entries, and other assigned finance functions.
• For FEP positions, processes all deferrals for FEP or edit corrections in computerized claims system.
• Performs complex FEP transactions (e.g., FEP Direct DDE, FEP Retro-enrollment, Out of Balance) and member appeals.

Benefits

• Highly competitive total rewards package, including comprehensive medical, dental and vision benefits.
• 401(k) plan that both the employee and employer contribute.
• Annual incentive bonus plan based on company achievement of goals.
• Time away from work including paid holidays, paid time off and volunteer time off.
• Professional development courses, mentorship opportunities, and tuition reimbursement program.
• Paid parental leave and adoption leave with adoption financial assistance.
• Employee discount program.

What This Job Offers

• Industry: Insurance Carriers and Related Activities
• Education Level: High school or GED