Claims Examiner
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Job Description
Remote Claims Examiner reviewing and processing healthcare claims for Blue Cross and Blue Shield of Kansas. Ensuring accurate coding, coverage decisions, compliance, and timely resolution.
Responsibilities:
- Review, analyze, and verify healthcare claims submitted by policyholders or medical providers
- Ensure documentation, ICD-10, CPT, HCPCS coding, and data are complete and accurate
- Check eligibility, coverage, and applicable benefits according to policy terms
- Enter and process claims information accurately in the system
- Apply deductibles, co-pays, co-insurance, and maximum coverage limits
- Approve or deny claims based on policy coverage and regulatory/company standards
- Adjust processed claims for corrective action
- Correspond with healthcare providers, patients, and internal departments to resolve discrepancies
- Investigate and resolve complex or escalated claim issues
- Ensure compliance with state and federal healthcare regulations
- Maintain accurate claims records for audits and reviews
- Meet individual and team performance targets for speed, accuracy, and quality
- Participate in ongoing training on policy and technology changes
- Monitor and work daily reports to ensure timely claim control
- Perform other assigned duties
Requirements:
- High school diploma or equivalent required
- Reside in Kansas or Missouri, or be willing to relocate as a condition of employment
- Previous experience in healthcare claims processing, medical billing, medical terminology, or health insurance preferred
- Knowledge of medical claim processing, medical terminology, insurance policies, and coding standards (ICD, CPT)
- Strong attention to detail and organizational skills
- Excellent written and verbal communication skills
- Ability to work efficiently under pressure and meet deadlines
- Critical thinking and problem-solving skills
- Office and/or computer system experience preferred
- Subject to pre-employment drug screening, criminal conviction check, employment verifications, and education verification
Benefits:
- Paid vacation and sick leave
- Paid maternity and paternity leave available immediately upon hire
- Incentive pay program (EPIP)
- Health, vision, and dental insurance
- 6 weeks paid parental leave for new mothers and fathers
- Fertility/adoption assistance
- 2 weeks paid caregiver leave
- 401(k) plan matching up to 5%
- Tuition reimbursement
- Health and fitness benefits, discounts and resources
- Ongoing training and development programs
- Flexible work environment
- Equal employment opportunities
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