Claims Processor II

Premera Blue Cross•WA Other Telecommuter, WA

4d•$41,500 - $71,100•Remote

About The Position

Join Our Team: Do Meaningful Work and Improve People’s Lives Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare. Premera is committed to being a workplace where people feel empowered to grow, innovate, and lead with purpose. By investing in our employees and fostering a culture of collaboration and continuous development, we’re able to better serve our customers. It’s this commitment that has earned us recognition as one of the best companies to work for. Learn more about our recent awards and recognitions as a greatest workplace. Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog: https://healthsource.premera.com/. Ready to take the next step in your career and deepen your claims expertise? The Claims Processor II role is an exciting internal opportunity to build on your knowledge of our members, systems, and processes while expanding your ability to resolve more complex claims. In this role, your accuracy, sound judgment, and commitment to quality will help ensure members and providers receive timely, reliable outcomes. You’ll also strengthen valuable skills in research, benefit interpretation, claims adjudication, and peer support—creating a strong foundation for continued growth within the organization. The Claims Processor II is responsible for the accurate and timely review, research, and resolution of moderately complex claims in accordance with contracts and policies. This may include subrogation, Medicare, and coordination of benefits for dental, medical and hospital claims. Incumbent is responsible for interpreting procedures and policies to ensure accurate claims resolution. Incumbent may also be responsible for processing simple and routine claims.

Requirements

High School diploma or GED (Required).
Six (6) months of claims processing experience or customer service experience (Required).
Experience with Out-of-area program.
Technical experience of contract benefits, claims processing steps, and correction procedures.

Responsibilities

Review, process, and resolve moderately complex claims in accordance with contracts and policies.
Research claims through the utilization of reference materials and on-line tools.
Responsible for accurately coding claims through the system.
Translate data into information acceptable to the claims processing system including follow up on pended claims.
Maintain all appropriate claims files and perform follow-up on pended claims.
Prepare claims for return to Provider or Subscriber when additional information is needed.
Demonstrate adjudication proficiency to meet or exceed accuracy goals.
Consistently meet cycle time/productivity goals that are aligned with corporate objectives.
Maintain confidentiality of all documents/files.
Contact other carriers or provider offices as necessary.
May provide `buddy training' and feedback to new associates.
May complete adjustments, reversals, and/or refunds.
Apply commitment to quality by doing things right the first time in order to avoid defects from reaching customers or requiring internal re-work.

Benefits

Medical, vision, and dental coverage with low employee premiums.
Voluntary benefit offerings, including pet insurance for paw parents.
Life and disability insurance.
Retirement programs, including a 401K employer match and, believe it or not, a pension plan that is vested after 3 years of service.
Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs, just to name a few.
Generous paid time off to reenergize.
Tuition assistance for both undergraduate and graduate degrees.
Employee recognition program to celebrate anniversaries, team accomplishments, and more.
Commuter perks make your trip to work less impactful on the environment and your wallet.
Free convenient on-site parking.
Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable.
Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.
Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.
Need a brain break? Challenge someone to a game of shuffleboard or ping pong while on campus.