Technical Sales Graduate, Sydney (Hybrid)
Hewlett Packard Enterprise
Help HPE customers shape networking, cloud, and data center solutions. Partner with account teams to move opportunities from qualification through closing.
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Arkansas Blue Cross and Blue Shield, Blue Cross and Blue Shield Association की एक स्वतंत्र लाइसेंसधारी संस्था है, जो Arkansas के सभी 75 काउंटियों में स्वास्थ्य बीमा प्रदान करती है। इसके विकल्पों में व्यक्तिगत और पारिवारिक कवरेज, Medicare और Medigap योजनाएँ, दंत और दृष्टि बीमा, यात्रा स्वास्थ्य योजनाएँ और नियोक्ता-प्रायोजित समूह कवरेज शामिल हैं।
कंपनी Blueprint Portal के माध्यम से सदस्यों की सहायता भी करती है। यह पोर्टल स्वास्थ्य योजनाओं के प्रबंधन, दावों की समीक्षा, स्वास्थ्य सेवा प्रदाताओं को खोजने और उपचार की अनुमानित लागत जानने के लिए विभिन्न उपकरण एक जगह उपलब्ध कराता है। इसका कार्य स्वास्थ्य बीमा सेवाओं, सदस्य सहायता और डिजिटल स्वास्थ्य-योजना प्रशासन तक फैला हुआ है।
Remote Medical Claims Specialist
Process medical claims that require manual review for Arkansas Blue Cross and Blue Shield, investigating benefits, eligibility, coding, audits, and processing issues. This full-time remote role is based in the United States.
विवरण
- Resolve medical claims that the system does not automatically adjudicate, meeting quality, accuracy, and productivity standards.
- Investigate claims and gather the information needed to complete them.
- Enter information into the claims system.
- Review and interpret contract benefits.
- Resolve claim edits and audit findings.
- Determine eligibility for benefits.
- Research processing issues using internal systems and manuals.
- Refer claims to other departments when needed.
- Consult internal colleagues and medical providers.
- Prepare correspondence and forms to request missing information.
- Complete initial instruction, on-the-job training, and ongoing education.
- Use relevant computer systems and screens to process claims accurately.
- Keep up with changes to processing procedures, benefits, and systems.
- Meet corporate and national MTM standards while maintaining departmental quality and productivity.
- Consult corporate and professional reference materials, including the company processing manual and ICD, CPT, and HCPS codebooks.
- Carry out other assigned duties.
आवश्यकताएँ
- High school diploma or equivalent.
- At least 48 semester hours of college coursework or equivalent certification focused on anatomy, medical terminology, math, biology, or a related field; alternatively, at least one year of related office experience in claims processing, health insurance, or a medical office.
- Pass the company Claims Assessment proficiency test.
- Oral and written communication skills.
- Strong interpersonal skills.
- Sound judgment.
- Decision-making ability.
- Attention to detail.
- Ability to work as part of a team.
- Dependability.
- Protect the security and confidentiality of records and information.
- Follow segregation of duties guidelines in the Administrative Manual.
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