Claims Processor I (Hybrid)

CareFirst BlueCross BlueShield is a healthcare organization, and they are seeking a Claims Processor I to review and adjudicate claims under direct supervision. This role involves examining claims, ensuring timely payments, and collaborating with various departments to resolve issues and answer processing questions.ResponsibilitiesUnder direct supervision, reviews and adjudicates paper/electronic claimsDetermines proper handling and adjudication of claims following organizational policies and proceduresExamines and resolves non-adjudicated claims to identify key elements of processing requirements based on contracts, policies and proceduresProcess product or system-specific claims to ensure timely payments are generated and calculate deductibles and maximums as well as research and resolve pending claimsThe Claims Processor also use automated system processes to send pending claims to ensure accurate completion according to medical policy, contracts, policies and procedures allowing timely considerations to be generated using multiple systemsCompletes research of proceduresApplies training materials, correspondence and medical policies to ensure claims are processed accuratelyPartners with Quality team for clarity on procedures and/or difficult claims and receives coaching from leadershipRequired participation in ongoing developmental training to performing daily functionsCompletes productivity daily data that is used by leadership to compile performance statisticsReports are used by management to plan for scheduling, quality improvement initiatives, workflow design and financial planning, etcCollaborates with multiple departments providing feedback and resolving issues and answering basic processing questionsSkillsHigh School Diploma or GEDLess than one year experience processing claim documentsDemonstrated analytical skillsDemonstrated reading comprehension and ability to follow directions providedBasic written/oral communication skillsDemonstrated ability to navigate computer applicationsMust be eligible to work in the U.S. without SponsorshipLess than one year claims processing, billing, or medical terminology experienceBenefitsComprehensive benefits packageVarious incentive programs/plans401k contribution programs/plansCompany OverviewCareFirst. It’s not just our name. It’s our promise. It was founded in 1934, and is headquartered in Baltimore, Maryland, USA, with a workforce of 5001-10000 employees. Its website is https://individual.carefirst.com.



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