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Claims Specialist
Location
United States
Posted
61 days ago
Salary
0
Seniority
Junior
Job Description
Claims Specialist
Arkansas Blue Cross and Blue Shield
• Claims processing involves the actions required to pay or deny pended claims (those which did not auto-adjudicate), including: entering data into the system; reviewing and interpreting contract benefits; conducting edit and audit resolution; determining benefit eligibility; Identifying and researching processing issues through systems and manuals; routing claims to other areas; consulting internal staff and medical providers; generating correspondence; and completing forms to obtain necessary information. • Knowledge/Continuous Learning: In order to perform the actions required of the Claim Specialist job, the incumbent must undergo initial training, on-the-job training, and continuing education. Demonstrating knowledge of and possessing the ability to access all relevant computer systems and screens in order to process claims accurately; staying current with continually changing processing procedures, benefits, and system modifications; being knowledgeable of and able to meet corporate and national (MTM) standards while maintaining acceptable performance levels based on established departmental standards for productivity and quality; and showing familiarity with corporate and professional manuals and guidebooks, including the company processing manual and ICD, CPT, and HCPS codebooks. • Other duties: As assigned.
Job Requirements
- High School diploma or equivalent.
- Minimum two (2) years' college coursework (48 semester hours) or other equivalent certification with an emphasis in anatomy, medical terminology, math, biology, or a related field.
- OR minimum one (1) year of related office experience such as claims processing, health insurance, or medical office.
- Must pass company proficiency test: Claims Assessment
Benefits
- Tuition reimbursement.
- Club Blue, a free, onsite gym to encourage exercise.
- Green Leaf Grill and Green Leaf Grill Express, onsite restaurants in Little Rock that promote healthy eating.
- Incentives for wellness education and exercise
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Claims Supervisor - Workers Compensation
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