Your Role
The Commercial First Pass Claims and Rework teams are responsible for processing work in enrollment, claims, provider, or other operational areas to meet operational, financial, and service requirements including timely and proper enrollment, adjudication of claims, or provider demographics updates in accordance with contractual requirements. The Claims Processor, Advanced will report to a Claims Operations Supervisor. In this role you will review and adjudicate complex/specialty paper/electronic claims and determine whether to return, deny, or pay claims following organizational policies and procedures, and may provide guidance or expertise to less experienced claims processors.
Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
Your Work
In this role, you will:
Be proficient in front and back-end processing
Process multiple claim types or specialties
Act as a Subject Matter Expert (SME) with one product cross functionally
Possess a solid understanding and knowledge of system processing with the ability to not only identify errors but to analyze and resolve them
Act as back-up for lead role Mentors associate and intermediate level rep
Make or receive calls regarding claims processing questions and clarifications and provide excellent customer service
Understand fundamentals of end-to-end (life of a clam) claims processing
Your Knowledge and Experience
Requires a High School Diploma or GED
Requires at least 5 years of prior relevant experience
Minimum years of 2 years of backend claims processing preferred
Experience with Microsoft office, including Microsoft Excel
Ability to process calculations for claims processing
Hybrid Virtual Work
This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.
Blue Shield of California strives to create a healthcare system worthy of its family and friends that is sustainably affordable. The health plan is a tax paying, nonprofit, independent member of the Blue Shield Association with nearly 6 million members, over 7,500 employees and more than $25 billion in annual revenue.
Founded in 1939 in San Francisco and now headquartered in Oakland, Blue Shield of California and its affiliates provide health, dental, vision, Medicaid and Medicare healthcare service plans in California. The company has contributed more than $60 million to Blue Shield of California Foundation in the last three years to have an impact on California communities.
For more news about Blue Shield of California, please visit news.blueshieldca.com.
