Claims Specialist I

Requirements

• Education High School Diploma or equivalent required
• Work Experience 6 months of experience in medical claims or health insurance-related customer service or the successful completion of BCBSLA adjustment or COB training
• Skills and Abilities Strong analytical ability, oral and written communication skills and human relations skills are necessary.
• Working knowledge of relevant PC software.
• Licenses and Certifications Certification in Medical Billing or Coding can be used in lieu of experience
• Communicates, both orally and in writing, with internal and external contacts in order to provide necessary and accurate information for the establishment of sound claim records. This may include, but is not limited to, the coordination of benefits (COB), medical record requests, etc.
• Review quality audits for correction or routing within 48 hours of receipt following departmental and corporate guidelines to ensure accuracy of claims processing and customer satisfaction.
• Steps in and assists in any other capacity as deemed necessary (i.e., training, implementations, and documentation).
• Additional Accountabilities and Essential Functions
• Job duties are performed in a normal and clean office environment with normal noise levels.
• Work is predominately done while standing or sitting.
• The ability to comprehend, document, calculate, visualize, and analyze are required.
• An Equal Opportunity Employer
• All internal employees please apply through Workday Careers.
• PLEASE USE A WEB BROWSER OTHER THAN INTERNET EXPLORER IF YOU ENCOUNTER ISSUES (CHROME, FIREFOX, SAFARI)
• Additional Information
• If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact recruiting@bcbsla.com

Benefits

Additional Information

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. We invite you to apply for a career with us. Residency in or relocation to Louisiana is preferred for all positions. POSITION PURPOSE 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 and initiating procedures to recover funds on overpaid claims. Accountable for complying with all laws and regulations that are associated with duties and responsibilities. NATURE AND SCOPE This role does not manage people This role reports to this job: SUPERVISOR, CLAIMS OPERATIONS Necessary Contacts: In order to effectively fulfill this position, the Claims Specialist I must be in contact with personnel in other Units: Various internal departments and staff including, but not limited to, Provider Services, Legal, Internal Audit, IT, other Benefits Operations Management and staff, Enrollment and Billing, Administrative Services, and District Offices. Various external entities including, but not limited to, Providers, Members, Lawyers, Groups, Commissioner of Insurance, other insurance companies, and other Plans.

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