Claims Processor I
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Job Description
Claims Processor I researching, correcting, and entering health insurance claims for Blue Cross and Blue Shield of Louisiana. Ensuring accurate adjudication, complete documentation, and timely processing.
Responsibilities:
- Research and verify complex claims information for accurate and timely claims processing
- Enter coded and other required information into claims systems
- Review and correct scanned claims documents
- Check claims for completeness and accuracy before final entry
- Identify and resolve inconsistencies and request missing information
- Ensure contract benefits are applied correctly
- Research procedural questions using supporting documentation and training manuals
- Identify incomplete adjudication instructions and suggest procedure updates
- Identify training issues and consult management when necessary
- Record daily production information including edits processed, hours worked, downtime, and special projects
- Reject, redirect, or return incomplete or inaccurate claims
- Maintain contact with internal departments, staff, providers, members, lawyers, insurers, and other external entities
- Perform other job-related duties within the scope of responsibilities
Requirements:
- High School Diploma or equivalent required
- Associate's degree preferred
- 1 year of related clerical or data entry experience required
- A medical office or medical coding diploma can be used in lieu of one year of experience
- Completion of the Medical Assistant, Coding & Insurance Pathway from BRCC can be used in lieu of one year of experience
- Claims processing or claims coding experience preferred
- Must be able to enter data at 4000 keystrokes per hour
- Medical coding training preferred
- Must demonstrate critical thinking and problem-solving skills
- Familiarity with medical and health insurance terminology preferred
- Demonstrated verbal and written communication skills
- Must demonstrate PC skills including Microsoft Office (Word, Excel, Outlook, etc.)
- No licenses or certifications required
- Residency in or relocation to Louisiana is preferred for all positions
- Must pass background and pre-employment drug screening; employment restrictions apply to certain felony convictions involving dishonesty or breach of trust
Benefits:
- Employee resources to live well, be healthy, continue learning, develop skills, grow professionally and serve local communities
- Smoke- and tobacco-free company properties
- Reasonable accommodations for individuals with disabilities
- Pre-employment drug screening and background screening after an offer
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