OPL Claims Correspondent

Blue Cross and Blue Shield of Kansas•Topeka, KS

6d•$21 - $27

About The Position

The OPL Claims Correspondent investigates and manages complex claims involving overlapping or duplicate coverage, auto/no-fault, workers’ compensation, and subrogation. The role performs investigations and calculations, coordinates claim adjustments, and supports accurate, efficient, and compliant claim resolution. The position may be performed remotely or onsite under the company’s Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.

Requirements

High school diploma or equivalent.
At least 1 year of claims processing experience, or at least 1 year of BCBSKS Customer Service experience.
Upon completion of training, knowledge of Claims and Membership policies, operating procedures, professional and institutional policies, contracts for all lines of business and product lines, and benefit coding.
Upon completion of training, knowledge of NAIC OPL regulations, workers’ compensation laws, the Kansas Automobile Injury Reparations Act, and subrogation.
Effective verbal, written, and interpersonal skills.
Current knowledge of state law, corporate contracts and policies, and NAIC guidelines concerning application of benefits for auto no-fault, workers’ compensation, duplicate coverage, and subrogation.
Upon completion of training, knowledge of Imaging, ACES, OTIS, MASK, Outlook, the FEP Washington system, TROVE, provider files, Check Free, IS12 (table inquiry), Client Letter, ITS system, CSI, and the Membership system.

Responsibilities

Research and investigate claims to determine payment liability for Other Party Liability issues.
Determine OPL situations and add appropriate notes and trailers to claims based on information from insureds, providers, other insurance companies, and outside vendors.
Perform online claim maintenance on records that result in system kick-outs requiring OPL investigation so claims can be paid accurately.
Analyze inquiries and research the appropriate action when OPL is involved.
Call outside entities to obtain eligibility information or clarify OPL circumstances.
Stay current on state law, corporate contracts and policies, and NAIC guidelines relating to auto/no-fault, workers’ compensation, duplicate coverage, and subrogation benefits.
Maintain detailed and accurate records of researched claims, including documentation for audits or reviews.
Refer claims for adjustments when corrective action is needed.