Claims Processor (Medicaid, hybrid)
Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. BCBSAZ offers 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.
This position requires work and residency in the state of Arizona.
Blue Cross Blue Shield of Arizona (BCBSAZ) is immediately hiring a full-time Claims Processor to help inspire a healthier Arizona. As our Claims Processor, you will come alongside our Reimbursement Services department to adjudicate incoming claims in accordance with policies, procedures, guidelines, regulatory requirements, and contractual agreements.
As you do, you’ll thrive in an energetic, diverse environment, championed by an organization consistently named a Best Places to Work and Most Admired Company in Arizona.
Inspiring Health in Arizona Starts with You
Our benefits support work-life balance and the flexibility you need to be your best.
Eleven (11) paid holidays, including a floating holiday you can use any time you wish
Accrued paid time off (up to 18 days per calendar year)
Comprehensive medical, dental, and vision coverage
401(k) up to 5% dollar-per-dollar match, 2% non-elective employer contribution
Eight (8) paid volunteer hours to support our mission of inspiring health
Tuition reimbursement for you; scholarship opportunities for your children
Employee discounts, gym reimbursement, and wellness programs
Treadmill desks, full-service fitness center, onsite cafeterias
Ongoing training for employees who wish to grow in their careers, acquire skills, and become managers
To thrive in this job, you must be able to:
- Maintain confidentiality and privacy
- Compose and dictate a variety of business correspondence
- Interpret and translate policies, procedures, programs, and guidelines
- Perform investigative and analytical research
- Maintain production and quality standards to help ensure claims are processed correctly the first time
- 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
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 a claim is not a duplicate of a 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
High school diploma or GED (required)
Associate degree in a general field of study (preferred)
At least one year of prior work experience
Experience with claims processing, including UB, 1500, and dental
BPT/HCPC and ICD10 coding skills
Knowledge of Medicaid and Medicare
Intermediate PC proficiency, including the ability to type at least 30 words per minute with 95% accuracy
Why Join Blue Cross Blue Shield of Arizona?
At BCBSAZ, your pursuit of balance, happiness, and fulfillment is supported through our Workability model. Workability is our workforce strategy and defines where and how we do our jobs.
Our award-winning healthy campus in Phoenix is always available to you. Access telehealth services at our BlueCare Anywhere kiosk, fuel up with healthy meals and snacks at our Work Perks Café, and make the most of our onsite fitness center by taking advantage of personal trainers, a nutritionist, Health Support programs, and daily group fitness classes, including spin, yoga, and Zumba.
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.