Claims Processor, Intermediate (ITS Host & Home)

About the role

The ITS Host and Home Claims teams process claims and adjustments for out-of-state Blue Cross Blue Shield members that receive services in California and for Blue Shield of California members that receive services performed outside of California. In this role, you will review and adjudicate claims and/or adjustments in accordance with provider contracts and organizational policies and procedures to meet operational, financial, and service requirements.

This role reports to the Operations Supervisor and allows for full-time virtual work, though employees may be expected to come to the office based on business need.

Responsibilities

• Perform back-end processing, resolving complex edits using available documents and job aids with minimal direction.
• Handle front-end processing and difficult adjustments.
• Complete special processing assignments; coordinate with other departments for resolution as needed.
• Understand the fundamentals of end-to-end (life of a claim) claims processing.
• Meet established performance metrics.

Requirements

• High school diploma or GED.
• At least 3 years of experience in claims processing or a related field.
• Healthcare claims knowledge preferred but not required.
• Healthcare operations or customer service experience preferred.
• Strong written and verbal communication skills.
• Ability to make and receive phone calls internally and externally while providing excellent customer service.

About Us

As of January 2025, Blue Shield of California became a subsidiary of Ascendium, a nonprofit corporate entity that includes Blue Shield of California, Blue Shield of California Promise Health Plan, Altais (a clinical services company), and Stellarus (a company designed to scale healthcare solutions). Together, these organizations form the Ascendium Family of Companies.

Blue Shield of California’s mission is to create a healthcare system worthy of our family and friends—one that is sustainably affordable. We are transforming healthcare by lowering costs, improving quality, and enhancing the member and physician experience. Our workplace fosters an environment where all employees can thrive and contribute to addressing the needs of the communities we serve.

Blue Shield has been recognized as a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company, and a Top 100 Inspiring Workplace. We were also named a Top Regional Company by Fair360 and one of the 50 most community-minded companies in the U.S. by Points of Light.

Values

• Honest: We hold ourselves to the highest ethical and integrity standards, building trust by doing what we say and correcting where we fall short.
• Human: We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous: We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Workplace Model

Our workplace model balances purposeful in-person collaboration with flexibility. Most teams come into the office two days per week. Employees living more than 50 miles from an office, out-of-state employees, and those in certain member-facing roles should work with their manager to determine in-office time based on business need. The company reserves the right to adjust requirements based on business needs.

For employees with medical conditions that may impact their ability to work in-office, we are committed to providing reasonable accommodations.

Physical Requirements

This role involves part- to full-time work in an office environment with sedentary deskwork for most of the workday.

Pay

• California: $20.13 to $28.18 per hour.
• Bay Area: $22.69 to $31.76 per hour.

Salaries are based on candidate experience, location, and current employee salaries for similar roles.

Schedule

Full time.

Locations

• Redding, CA, United States
• El Dorado Hills, CA, United States
• Lodi, CA, United States
• Rancho Cordova, CA, United States