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Claims Processor, Intermediate
1 month ago
Your Role The Commercial First Pass Claims team is responsible for processing work in Enrollment, Claims, Provider, or other operational area to meet operational, financial, and service requirements including timely and proper enrollment, adjudication of claims, or provider demographics updates in accordance with contractual requirements. The Claims Processor reviews and adjudicates complex/specialty paper/electronic claims. Determines whether to return, deny, or pay claims following organizational policies and procedures. May provide guidance or expertise to less experienced claims processors The Claims Processor will report to the Supervisor of Operations, Julie Pendergrass. In this role you will review and adjudicate complex/specialty paper/electronic claims. Determines whether to return, deny, or pay claims following organizational policies and procedures. May provide guidance or expertise to less experienced claims processors. Your Work In this role, you will: Be experienced in back-end processing; proficient in resolving complex edits using available documents/job aids with minimum direction Experience front-end processing and difficult adjustments Be given special processing assignments; coordinate with other departments for resolution if needed Understand fundamentals of end-to-end (life of a clam) claims processing Perform established performance metrics Strong ability to manage time effectively, multi-task, detailed research skills, meet deadlines with excellent quality Ability to work independently as well as in a team environment Ability to perform basic writing and arithmetic Candidate must be able to make or receive calls regarding claims processing questions and clarifications and be able to perform excellent customer service. Adhere to assigned schedule. Your Knowledge and Experience Requires a high school diploma or GED Requires at least 3 years of experience Basic experience in Microsoft Office Experience with excel preferred Math skills preferred Pay Range: The pay range for this role is: $ 18.61 to $ 26.05 for California. Note: Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.
