직무 설명

Role Overview

This position involves supervised review and adjudication of paper and electronic claims, ensuring claims are handled in accordance with organizational policies and procedures to facilitate timely payments.

Key Responsibilities

Review and resolve claims that have not been adjudicated by identifying processing requirements based on contracts, policies, and procedures. Process product- or system-specific claims, calculate deductibles and maximums, and work to resolve pending claims using automated systems to ensure accurate and timely payments.
Conduct research related to procedures, apply training materials, correspondence, and medical policies to guarantee accurate claim processing. Collaborate with the Quality team for clarification on procedures or complex claims and participate in ongoing training and coaching from leadership.
Maintain daily productivity data utilized by management for performance statistics, scheduling, quality improvement, workflow design, and financial planning.
Work collaboratively across departments by providing feedback, resolving issues, and responding to basic processing inquiries.

Qualifications and Skills

High school diploma or GED required.
Less than one year of claim processing experience required; preferred qualifications include under one year of claims processing, billing, or medical terminology experience.
Strong analytical skills and ability to comprehend reading materials and follow directions.
Basic oral and written communication skills.
Computer application navigation proficiency.
Capable of meeting deadlines, managing multiple customer service demands, and delivering positive service to internal and external customers, including those with challenging needs.

Compensation and Benefits

The salary ranges between $33,408 and $61,248 annually, not adjusted for geographic differences. Compensation takes into account position responsibilities, candidate experience, education, peer equity, and market factors. Typically, hiring at the top salary range is rare and depends on individual circumstances. Additional benefits include a comprehensive benefits package, various incentive programs, and 401k contributions, all subject to eligibility.

Additional Information

CareFirst BlueCross BlueShield is committed to equal employment opportunities without discrimination based on color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Applicants must immediately disclose any ineligibility related to federal healthcare program participation. The role typically requires seated work, occasional walking or standing, frequent use of hands for typing and handling small objects, frequent talking and hearing, and occasional lifting of up to 25 pounds.

U.S. work authorization without sponsorship is required.

Claims Processor I (Remote)