Claims Representative

Blue Cross and Blue Shield of North Carolina • Remote Flex - North Carolina, SC

2d • $41,600 - $66,561 • Hybrid

About The Position

We’re hiring a Claims Representative to join the Claims Team! Under direct supervision, the Claims Representative reviews and timely adjudicates claims and administers them in accordance with contractual benefits and health care policies. The Claims Representative is responsible for managing daily work queues, quality of claims processed and final resolution. Also monitors claim turnaround times to assure all compliance guidelines are met as well as performance guarantees. Claims reviewed are for singular business segment and/or singular claims-provider type.

Requirements

• High school diploma or GED
• 0-2 years of experience in related field.

Nice To Haves

• Data entry experience is a plus.

Responsibilities

• Process, adjust or update various routine claims payments and payment errors for singular business segment and/or claims-provider type
• Respond promptly and accurately to inquiries from Core Service, subscribers, providers, physicians and other insurance carriers regarding claims payments
• Meet or exceed established quality and performance standards
• Determine suspended claim resolution methods by reviewing benefit eligibility, claims history and other information
• Identify system problems, including documentation of the issue, recommendation of potential solutions, referral to appropriate technical staff and follow-up to ensure resolution
• Assist management by identifying and analyzing opportunities for improvements in BCBSNC processes, policies and services
• May coordinate with other insurance carriers and Medicare to determine BCBSNC payment liability
• Review claims for possible “fraud and abuse” and send to Special Investigations Unit for additional investigation

Benefits

• Medical, dental, and vision coverage along with numerous health and wellness programs
• Parental leave and support plus adoption and surrogacy assistance
• Career development programs and tuition reimbursement for continued education
• 401k match including an annual company contribution

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED