Pricer VII St Wide Call In

Blue Cross Blue Shield of Michigan • Lansing, MI

14h

About The Position

Responsible for adjustment processing of claims received via telephone or written inquiry from internal customers. Handle telephone inquiries generated from all internal customer and provider servicing areas and adjust claims as appropriate based on nature of call. Contact internal and external resources via phone or written communication for additional information required to process claim payments. Complete written inquiries generated from all corporate customer and provider servicing areas and adjust claims as appropriate based on worksheet instructions. Research and recommend solutions to expedite aged claims for payment or closure utilizing internal and external systems. Finalize pricing edits for all claim types. Notify leadership of system problems or possible fraud situations. Perform other related duties as assigned.

Requirements

• High school graduate or GED equivalent is required.
• Two (2) years of previous call center experience.
• Claim processing experience preferred.
• Verbal and written communication skills required to obtain information and prepare correspondence.
• Math skills required to calculate payment amounts and adjustments.
• Analytical skills necessary for benefit interpretation and application.
• Other related skills and/or abilities may be required to perform this job.
• Successful completion of Entry Level Pricer Selection System.
• Other related skills and/or abilities may be required to perform this job.
• All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.

Nice To Haves

• Claim processing experience preferred.

Responsibilities

• Adjustment processing of claims received via telephone or written inquiry from internal customers.
• Handle telephone inquiries generated from all internal customer and provider servicing areas and adjust claims as appropriate based on nature of call.
• Contact internal and external resources via phone or written communication for additional information required to process claim payments.
• Complete written inquiries generated from all corporate customer and provider servicing areas and adjust claims as appropriate based on worksheet instructions.
• Research and recommend solutions to expedite aged claims for payment or closure utilizing internal and external systems.
• Finalize pricing edits for all claim types.
• Notify leadership of system problems or possible fraud situations.
• Perform other related duties as assigned.

What This Job Offers

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