[Hiring] Claims Correspondent @Blue Cross and Blue Shield of Kansas

Role Description

The OPL Claims Correspondent investigates and manages complex claims involving overlapping or duplicate coverage, auto/no-fault, workers' compensation, and subrogation. By performing OPL investigations, calculations, coordinating adjustments, and ensuring accurate claim resolution, the role supports efficient, accurate, and compliant claims operations.

What you'll do

• Research and investigate claims received to determine payment liability (Other Party Liability issues).
• Determine OPL situations and properly load the appropriate notes/trailers from research on claims based on information received from insureds, providers, other insurance companies, and outside vendors.
• Handle online claim maintenance to records which result in system "kick-outs" of claims needing OPL investigation to allow the accurate payment of claims.
• Analyze inquiry and conduct research to determine appropriate action on claims when OPL is involved.
• Initiate phone calls to outside entities to obtain eligibility information or clarify OPL circumstances.
• Remain current on state law, corporate contract and policy, and NAIC guidelines relative to the application of contract benefits for auto/no-fault, worker's compensation, duplicate coverage, and subrogation.
• Maintain detailed and accurate records of all claims researched, including documentation for audits or reviews.
• Refer claims for adjustments as needed for corrective action.

Qualifications

• High school diploma or equivalent required.
• Minimum 1 year of claims processing experience required or minimum 1 year of BCBSKS Customer Service experience required.

Requirements

• No travel required.
• Upon completion of training, must be knowledgeable of all Claims and Membership policies, operating procedures, professional and institutional policies, contracts for all lines of business/product lines, and benefit coding.
• Upon completion of training, knowledge of NAIC OPL regulations, workers' compensation laws, Kansas Automobile Injury Reparations Act, and subrogation.
• Effective verbal, written, and human relation skills.
• Current knowledge on state law, corporate contract and policy, and NAIC guidelines relative to application of contract benefits for auto no-fault, workers' compensation, duplicate coverage, and subrogation.
• Upon completion of training, knowledge of the following systems is required: Imaging, ACES, OTIS, MASK, Outlook, the FEP Washington system, TROVE, provider files, Check Free, IS12 (table inquiry), Client Letter, ITS system, CSI, and the Membership system.

Compensation

$21.46 - $26.83 hourly

Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.

Benefits

• Base compensation is only one component of your competitive Total Rewards package.
• Incentive pay program (EPIP).
• Health/Vision/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 & fitness benefits, discounts, and resources.