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

Role Description

This position supports the claims unit with the following responsibilities:

• 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.
• Working knowledge of relevant PC software.
• Certification in Medical Billing or Coding can be used in lieu of experience.

Requirements

• Reviews, researches, and updates claims, including recalculation of benefits and processing of claims edits.
• Achieves and maintains understanding of systems, applications, and procedures for claims processing.
• Communicates with internal and external contacts for accurate claim records.
• Reviews quality audits for correction within 48 hours following guidelines.
• Researches and determines correct order of benefits for payment.
• Assists in other capacities as necessary (training, implementations, documentation).
• Performs job-related duties in a normal office environment.
• Ability to comprehend, document, calculate, visualize, and analyze.

Benefits

• Resources to live well and be healthy.
• Opportunities for continued learning and professional growth.
• Support for serving local communities.