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We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC . If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: HR.Staffing@BCBSNC.com .
Senior Claims Specialist
Location
United States
Posted
10 days ago
Salary
$45.8K - $73.2K / year
Seniority
Senior
No structured requirement data.
Job Description
Senior Claims Specialist
Blue Cross and Blue Shield of North Carolina
Role Description The Claims Operations Expert is a subject matter expert that enables accelerated claims resolution and production support to manage inventory. Responsibilities include: - Resolve escalated claims from less experienced team members following the formal escalation protocol. - Manage work production schedule to balance provider segment preference and staff availability. - Identify and resolve errors on custom or special project claims. What You'll Do: - Serve as a subject matter expert for employees’ inquiries around work process, procedures, products, policies, etc. - Process a variety of customer transactions that may include non-routine suspended claims, inquiries, adjustments, and correspondence for any business segment. - Contribute in sessions to discuss claims processing workflow and make improvement suggestions to speed up overall claims quality and lead time. - Identify problems, gaps or inconsistencies in workflows and processes; recommend updates, alternatives and/or solutions. - Assist training team in development of claims production staff to be customer centric, cross functional, data driven personnel. - Support Provider Services in resolving immediate issues directly impacting provider financial well-being. - Review claims for possible “fraud” and identify root cause by conducting forensic analysis to the problem. - Serve as subject matter expert for project, testing, and validation of claims work processes and procedures. - Communicate with Customer Service and Provider Services to understand key focus of service segment. - Act as a point of contact for NCQA and NCDOI for compliance. - Act as a point of contact for internal and/or external audits and projects as necessary; assist in planning, scoping, testing, training and implementation. - Identify and document escalated, recurring or complex system and process problems. - Interface with project teams to resolve these complex issues. Qualifications - High school diploma or GED. - 5+ years of experience in related field. Requirements - Claims Analysis - Claims Management - Claims Operations - Claims Processing - Claims Resolution - Claims Support - Health Insurance Portability & Accountability Act (HIPAA) - Insurance - Insurance Claim Handling - Insurance Claims Investigations - Insurance Procedures - Medical Claims - People Management - Workflow Management Benefits - Annual Incentive Bonus* based on annual corporate goal achievement and individual performance. - 401(k) with employer match. - Paid Time Off (PTO). - Competitive health benefits and wellness programs. Salary Range $45,761.00 - $73,217.00 Job Alert Fraud We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC . If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: HR.Staffing@BCBSNC.com .
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