[Hiring] Claims Specialist I @Blue Cross and Blue Shield of Louisiana

Role Description

This role does not manage people and reports to the Supervisor, Claims Operations. Duties may include the following responsibilities or functions required to support the claims unit:

• Accurate processing of claims edits.
• Determining primacy for the Coordination of Benefits (COB).
• Adjusting previously paid claims.
• Initiating procedures to recover funds on overpaid claims.
• Accountable for complying with all laws and regulations associated with duties and responsibilities.

Qualifications

• High School Diploma or equivalent required.
• 6 months of experience in medical claims or health insurance-related customer service or successful completion of BCBSLA adjustment or COB training.
• Strong analytical ability, oral and written communication skills, and human relations skills are necessary.
• Working knowledge of relevant PC software.
• Certification in Medical Billing or Coding can be used in lieu of experience.

Requirements

• Reviews, researches, and makes necessary updates to claims, including recalculation of benefits to previously processed claims.
• Processes claims edits or initiates refund requests according to contractual benefits or provider reimbursement rules.
• Achieves and maintains a clear understanding of all systems, applications, and procedures necessary to identify denial codes, edits, and processing codes.
• Communicates with internal and external contacts to provide necessary and accurate information for the establishment of sound claim records.
• Reviews quality audits for correction or routing within 48 hours of receipt following departmental and corporate guidelines.
• Researches, investigates, and determines the correct order of benefits for payment to be made by the applicable plans.
• Steps in and assists in any other capacity as deemed necessary (i.e., training, implementations, and documentation).

Benefits

• We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally, and serve our local communities.
• Work environment that will optimize personal health and well-being.
• Smoke and tobacco-free company properties.