Claims Processor I-II (AZ Remote)
Job Description
Awarded the Best Place to Work 2021, Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
The remote work opportunity requires residency, and work to be performed within the State of Arizona.
PURPOSE OF THE JOB
Claims Processors adjudicate incoming claims in accordance with policies, procedures, and guidelines (as outlined by the company) regulatory requirements and contractual agreements. Processors are subject to production and quality standards to help ensure claims are processed correctly the first time.
QUALIFICATIONS
REQUIRED QUALIFICATIONS
Required Work Experience
1+ years
Required Education
High School Diploma or GED
Required Licenses
N/A
Required Certifications
N/A
PREFERRED QUALIFICATIONS
Preferred Work Experience
N/A
Preferred Education
Associate's Degree in general field of study
Preferred Licenses
N/A
Preferred Certifications
N/A
ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES
Adjudicate claims according to regulatory, contractual and health plan requirements
Pre-screen accuracy of EDI submissions through review of data elements in claims system
Verify claim is not duplicate of previously submitted claim
Keep updated with processing manual and other educational/training materials
Know and adjudicate claims according to COB provisions
Identify and refer TPL issues to appropriate department
Identify and refer medical review claims to appropriate department
Identify and refer potential FWA claims to appropriate department
Identify opportunities for provider education
Identify opportunities for process improvement, including auto adjudication
Perform all other duties as assigned
The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements
COMPETENCIES
REQUIRED COMPETENCIES
Required Job Skills
Claims processing, including UB, 1500 and dental
Medical terminology
CPT/HCPC and ICD10 coding
Medicaid and Medicare
Experience with multi-tasking and prioritizing
Type 30 to 35 words per minute with 5% error rate or less
Intermediate PC proficiency
Strong oral and written communication skills
Proficient spelling, punctuation and grammar skills
Required Professional Competencies
Maintain confidentiality and privacy
Compose and dictate a variety of business correspondence
Interpret and translate policies, procedures, programs and guidelines
Capable of investigative and analytical research
Navigate, gather, input and maintain data records in multiple system applications
Follow and accept instruction and direction
Establish and maintain working relationships in a collaborative team environment
Required Leadership Experience and Competencies
N/A
PREFERRED COMPETENCIES
Preferred Job Skills
Type >35 words per minute with 5% error rate or less
Intermediate knowledge of CPT, HCPCS and ICD9 claim coding
Intermediate understanding of dental and medical terminology
Intermediate comprehension of anatomy and medical practices
Bilingual (Spanish/English) skill in written communication
Preferred Professional Competencies
Knowledge of a wide range of subjects pertaining to the organization's service and operations
Preferred Leadership Experience and Competencies
N/A
Our Commitment
BCBSAZ does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.
Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.
Application Instructions
Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!
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