Claims Specialist III

5 hours ago


Baton Rouge, Louisiana, United States Blue Cross and Blue Shield of Louisiana Full time
Job Title: Claims Specialist III

We are seeking a highly skilled Claims Specialist III to join our team at Blue Cross and Blue Shield of Louisiana. As a key member of our claims unit, you will play a critical role in ensuring the accurate and timely processing of complex claims and adjustments.

Key Responsibilities:
  • Review and research claims to ensure accuracy and compliance with contractual benefits and provider reimbursement rules.
  • Analyze and investigate problem cases, including COB records, adjusting previously processed claims, and requesting refunds for overpaid claims.
  • Communicate with internal and external contacts to provide necessary information for claim records, including coordination of benefits, medical record requests, and other related matters.
  • Execute procedures to recover funds from providers, subscribers, or beneficiaries where overpayments have occurred.
  • Assist in developing, documenting, testing, and approving system changes to ensure processing accuracy and prevention of unintended downstream impacts.
Requirements:
  • 4 years of experience in Coordinator of Benefits (COB) or adjustments/refunds processing required.
  • Self-funded processing experience preferred.
  • Strong analytical ability, including logical, systemic, and investigative thinking.
  • Excellent oral and written communication skills and interpersonal skills.
  • Working knowledge of relevant PC software.
  • Full understanding of claims procedures, primacy rules, and claims processing guidelines.
What We Offer:
  • A competitive salary and benefits package.
  • The opportunity to work with a dynamic team in a fast-paced environment.
  • Professional development and growth opportunities.

Please note that this job description is not intended to be a comprehensive list of all duties, responsibilities, or qualifications required of the job holder. The job holder may be required to perform other related duties as assigned by management.


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