Claims Technician, Springfield IL

HCSC•Springfield, IL

3d•Hybrid

About The Position

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. BASIC FUNCTION Under supervision, this position is responsible for processing complex claims requiring further investigation, including coordination of benefits and resolving pended claims. The Claim Technician is responsible for reviewing, processing, and adjudicating healthcare claims accurately and efficiently in accordance with company policies, payer guidelines, and regulatory requirements. This role investigates claim discrepancies, researches denials, verifies member and provider information, and ensures timely claim resolution. The Claims Technician also collaborates with internal departments, providers, and members to resolve claim issues while maintaining high standards of accuracy, productivity, compliance, and customer service. The ideal candidate demonstrates strong analytical skills, attention to detail, and knowledge of healthcare claims processing, medical terminology, and applicable regulations, including HIPAA. NOTE: there is a mandatory onsite training (13 weeks) with strict attendance requirements occurring Monday-Friday (8am to 4:30pm). Upon successful completion of this training, work from home provisions will be established. The hourly rate for this role has been approved between $17.75 to $18.25. Relocation is not offered; sponsorship is not available.

Requirements

High School degree or GED.
Strong data entry and/or typing experience.
Experience processing medical claims.
PC experience including Windows and Microsoft Office.
Strong attention to detail, problem-solving, and organizational skills.
Clear and concise verbal and written communication skills.

Nice To Haves

Must have trained on the Blue Chip claims processing system OR have the ability to fully complete the Blue Chip Training class.
Knowledge of medical terminology and CPT, HCPCS, and ICD9 coding.
Knowledge of coordination of benefits principles and terminology.
Experience with multi-tasking and prioritizing.
Familiarity with claims adjudication systems and healthcare payer processes.
Experience working BlueCard Medical Records and BlueCard Adjustment requests and responses.

Responsibilities

Process complex claims in various queues.
Conduct research and investigation into missing information, make phone calls to providers (as necessary), access resource materials and support files in order to process and adjudicate claims timely and accurately.
Resolve complex pended claims, duplicate claims and adjustments.
Process claims, involving communications with participating plans and/or Service Units.
Resolve various issues.
Research and identify other insurance, Medicare, Medicaid and update patient file as needed.
Coordinate benefits; request explanation of benefits as needed.
Maintain a working understanding of medical terminology and CPT, HCPCS, and ICD9 coding.
Maintain knowledge related to specific contracts.
Read appropriate files in IMAGE and apply information to claims as needed using the Financial Suspense System (FSS).
Learn and maintain knowledge of DOL ERISA and prompt pay legislation.