Job Description

Your Role

The Blue Shield of California Claims teams process claims and adjustments for Blue Shield of California members that receive services performed in, or our outside of California. The Claims Processor, Intermediate will report to the Operations Supervisor. In this role you will be responsible for reviewing and adjudicating claims and/or adjustments in accordance with provider contracts and organizational policies and procedures to meet operational, financial, and service requirements.

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 experienced in back-end processing; proficient in resolving complex edits using available. documents/job aids with minimum direction.
• Experience front-end processing and difficult adjustments and multiple claim types.
• Be given special processing assignments; coordinate with other departments for resolution if needed.
• Coordinate with internal partners to resolve processing issues requiring cross-functional input.
• Apply working knowledge of end-to-end claims processing to meet quality and productivity standards.
• Provide claims support within the Commercial, IFP, Medicare, Medi-Cal, FEP, ITS Home, ITS Host, or CalPERS lines of business.
• Other duties as assigned.

Future Opportunities

Great talent is always in demand at Blue Shield of California. While there is not a current opening associated with this posting, we are proactively building a network of qualified candidates for future opportunities. We encourage you to apply and stay connected for upcoming roles that align with your skills and interests.

Your Knowledge and Experience

Claims Processor, Intermediate

• High School Diploma or GED or 1 year of additional relevant experience in lieu of a diploma
• Requires 3 years of relevant experience
• Knowledge of medical plans and benefits
• Requires basic job knowledge of systems and procedures within Claims Processing
• Understands fundamentals of end-to-end (life of a claim) claims processing
• Experienced in back-end processing, proficient in resolving complex edits
• Intermediate-Advanced skills creating documents/files using Excel, Outlook, PowerPoint, and Word

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.