OPL Claims Correspondent

Blue Cross and Blue Shield of Kansas•Wichita, KS

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 position performs investigations and calculations, coordinates adjustments, and supports accurate, efficient, and compliant claim resolution. The role may be performed remotely or onsite in accordance with the company’s Telecommuting Policy. Applicants must reside in Kansas or Missouri, or be willing to relocate as a condition of employment. No travel is required. The position is non-exempt and pays $21.46–$26.83 per hour.

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 applicable state law, corporate contract and policy, and NAIC guidelines for auto/no-fault, workers’ compensation, duplicate coverage, and subrogation.
Upon completion of training, knowledge of the following systems: 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.
Must reside in Kansas or Missouri, or be willing to relocate as a condition of employment.

Responsibilities

Research and investigate claims to determine payment liability for Other Party Liability issues.
Determine OPL situations and enter appropriate notes or trailers based on information received from insureds, providers, other insurance companies, and outside vendors.
Maintain claims online when system kick-outs require OPL investigation so claims can be paid accurately.
Analyze inquiries and research claims to determine 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 related to benefits for auto/no-fault, workers’ compensation, duplicate coverage, and subrogation.
Maintain detailed and accurate records of researched claims, including documentation for audits or reviews.
Refer claims for adjustments when corrective action is needed.