Claims Examiner I
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Job Description
Claims Examiner assessing and processing complex insurance claims at Blue Cross and Blue Shield of Kansas City. Requires strong customer service skills and background in claims processing.
Responsibilities:
- Under general supervision, assesses claim information, references contracts and performs calculations and other functions to accomplish the processing and payment of insurance claims of a complicated or non-routine nature.
- Interprets contract information and communicates with outside parties to obtain information and coordinate coverage.
- Performs claim research and adjustments.
- Successfully completes all training programs as required for the level.
- Processes claims for two products or claim types (dental, hospital, medical, ITS, FEP).
- Performs research and adjustment functions for claims.
- Perform special projects (e.g., complex accumulator reconsiderations, New Directions).
- Responds to written inquiries from internal and external customers as business needs dictate.
- Sets up deducts, CLOV table entries, and other assigned finance functions.
- For FEP positions, processes all deferrals for FEP or edit corrections in computerized claims system.
- Performs complex FEP transactions (e.g., FEP Direct DDE, FEP Retro-enrollment, Out of Balance) and member appeals.
Requirements:
- High school diploma or general education degree (GED)
- 2 years of previous customer service, member services, or claims processing experience; or any combination of required education and experience.
- Advanced Keyboarding Knowledge
- Intermediate knowledge of Microsoft Office
- Knowledge of FACETS and/or other computerized claims processing system as applicable (FEP).
- Associates degree from college or technical school
Benefits:
- Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute
- Annual incentive bonus plan based on company achievement of goals
- Time away from work including paid holidays, paid time off and volunteer time off
- Professional development courses, mentorship opportunities, and tuition reimbursement program
- Paid parental leave and adoption leave with adoption financial assistance
- Employee discount program
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