Claims Examiner I
Job Description
Successfully completes all training programs as required for the level.
- Processes claims for two products or claim types (dental, hospital, medical, ITS, FEP).
- Performs research and adjustment functions for claims.
- Performs special projects (e.g., complex accumulator reconsiderations, New Directions).
- Responds to written inquiries from internal and external customers as business needs dictate.
- Sets up deducts, CLOV table entries, and other assigned finance functions.
- For FEP positions, processes all deferrals for FEP or edit corrections in computerized claims system.
- Performs complex FEP transactions (e.g., FEP Direct DDE, FEP Retro-enrollment, Out of Balance) and member appeals.
Requirements
- High school diploma or general education degree (GED).
- 2 years of previous customer service, member services, or claims processing experience; or any combination of required education and experience.
- Advanced Keyboarding Knowledge
- Intermediate knowledge of Microsoft Office
Qualifications
- Associates degree from college or technical school
Skills
- Knowledge of FACETS and/or other computerized claims processing system as applicable (FEP)
Pay
Competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute.
Schedule
Annual incentive bonus plan based on company achievement of goals
Benefits
Time away from work including paid holidays, paid time off and volunteer time off
Professional development courses, mentorship opportunities, and tuition reimbursement program
Paid parental leave and adoption leave with adoption financial assistance
Employee discount program
About the Role
Guided by our core values and commitment to your success, we provide health, financial and lifestyle benefits to ensure a best-in-class employee experience.
Some of our offerings include:
- Hightly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute
- Annual incentive bonus plan based on company achievement of goals
- Time away from work including paid holidays, paid time off and volunteer time off
- Professional development courses, mentorship opportunities, and tuition reimbursement program
- Paid parental leave and adoption leave with adoption financial assistance
- Employee discount program
Company Information
Blue Cross and Blue Shield of Kansas City is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, color, religion, sex, sexual orientation, gender identity, national origin, age, status as a protected veteran, or disability.