Claims Adjuster

Responsibilities

• Performs retrospective claim adjustments that include identifying overpayments, underpayments, system configuration issues and correcting as appropriate.
• Analyze external and internal inquiries to identify required claim adjustments.
• Process claims as needed by analyzing international claims to identify the claimant, type of services rendered and charge for each and comparing each claim to customer’s policy coverage provisions.
• Communicate claim adjudication and/or adjustment analyses to internal departments, internal teams, members, and providers.
• Accurately process medical claim adjustments into the claims system in adherence to BCBS Global Solutions SM /HTH standards.
• Reporting error trends that are detected for future educational training purposes.
• Maintain required departmental production and quality standards.
• Keep Manager advised of status of workload and identify problems for which help is needed.
• Follow regulations and company rules and policies as outlined in the Employee Handbook.

Requirements

• High school diploma or equivalent required.
• Some college/degree a plus.
• Minimum - three years of experience in the health insurance industry examining and adjudicating medical claims preferably with exposure to stating plan features and benefits and helping to resolve claims related issues.
• Familiarity with insurance products and insurance terminology, including CPT and ICD-9 coding.
• Coding Certificate desired (CPC, CCS).
• Excellent verbal and written communication skills and ability to effectively deal with customer complaints and concerns.
• Work organization, problem solving, and basic math skills.
• Ability to make decisions and support them with documentation.
• Knowledge of, and the ability to learn: Microsoft Office Products, Internal software systems, the internet and overall familiarity with personal computers is required, as well as the ability to work with dual computer monitors preferred.
• Salesforce experience a plus.

Qualifications

Employee is required to have at minimum an internet speed of 75 Mbps (standard high-speed internet access).

Benefits

• Competitive base pay + annual bonus
• Competitive medical plans
• Telemedicine services
• Paid parental leave
• 24/7 employee assistance and wellness support
• Free international healthcare coverage
• Other great perks: Remote work, Work-abroad arrangements available, Generous PTO accrual with carry-over options, 9 paid holidays, plus one floating holiday and one volunteer day, Tuition reimbursement, Career development and learning opportunities, 401(k) with generous company match, Pet insurance options, Identity theft and legal coverage, Ongoing focus on well-being, including virtual wellness resources and mindfulness events

Pay

Compensation is based on prior/relevant experience and skill level in a similar role. Competitive base pay starting at $23.23/hr.

Schedule

Flexibility to work in an office and/or at-home, remote office environment. Overtime and/or schedule flexibility are occasionally necessary in this position. Individual may be required to attend key business/departmental meetings and/or perform certain business critical job functions outside of normal working hours.