Claims Processor III

6 days ago


Baltimore, Maryland, United States CareFirst BlueCross BlueShield Full time

Job Summary:

CareFirst BlueCross BlueShield is seeking a skilled Claims Processor III to join our team. In this role, you will be responsible for reviewing and adjudicating complex paper/electronic claims, determining proper handling and adjudication of claims following organizational policies and procedures, and providing leadership to less experienced staff through mentoring and training.

Key Responsibilities:

  • Uses expert knowledge of systems to process all types and dollar level of claims and to identify key elements and processing requirements based on diagnosis, provider, medical policy, contracts, policies and procedures.
  • Utilizes the quality team for assistance on unclear procedures and/or difficult claims and receives coaching from leadership.
  • Completes productivity data daily that is used by leadership to compile performance statistics.
  • Provides leadership to less experienced staff through mentoring or training.
  • Assists Customer Service Reps by providing feedback and resolving issues and answering basic processing questions.

Requirements:

  • High School Diploma or GED.
  • 5 years claims experience required.
  • Preferred Qualifications: 5 or more years claims processing, billing or medical terminology experience.

What We Offer:

CareFirst BlueCross BlueShield offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Equal Employment Opportunity:

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.



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