Claims Research Associate - High School Graduate

About the role

The Claims Research Associate position at Blue Cross and Blue Shield of Alabama is responsible for medical claims processing and inquiry resolution. Responsibilities include reviewing claims for errors, analyzing claims, updating benefits, rejecting or redirecting misrouted inquiries, and communicating with customers and colleagues.

Responsibilities

• Process claims according to business regulations, internal standards, and processing guidelines.
• Analyze claims and make necessary updates, including recalculation of benefits for previously processed claims.
• Reject, redirect, or ask clarifying questions for inquiries with incomplete or inaccurate information to ensure timely processing.
• Communicate via inquiry, email, and telecommunication across multiple areas of the company to ensure customer resolution is complete.

Qualifications

• High School Diploma or equivalent within the last 12 months.
• Experience interacting with customers or peers.
• Problem-solving and analytical skills.
• Time management and organizational skills.
• Research skills using a computer.
• Strong communication skills (both oral and written).
• Familiarity with Microsoft Office (Word, Excel, PowerPoint, etc.).
• Experience with production, accuracy, and/or timeliness requirements.
• Ability to adjust and adapt to necessary changes due to business needs.

Benefits

The program is structured into three phases: training, benchmark, and fluency. The maximum duration of the program for each incumbent for phase one (classroom training) is up to 8 weeks depending on the training program; while phase two can last as long as 18 weeks (benchmark/practical application). For an associate to reach phase three training (fluency), the incumbent must meet production, timeliness and quality goals that are in place under phase two. The fluency phase will last 13 weeks.

Pay

The pay for this position is commensurate with experience.

Schedule

The work location for this position will be full-time onsite during the training program, which consists of multiple phases. Remote/hybrid schedules may be available once all phases of training program have been completed.