Arkansas Blue Cross and Blue Shield is an independent Blue Cross and Blue Shield Association licensee providing health insurance across all 75 counties of Arkansas. Its offerings include individual and family coverage, Medicare and Medigap plans, dental and vision insurance, travel health plans, and employer-sponsored group coverage.
The company also supports members through the Blueprint Portal, which brings together tools for managing health plans, reviewing claims, locating healthcare providers, and estimating treatment costs. Its work spans healthcare insurance services, member support, and digital health-plan administration.
Remote Claims Specialist at Arkansas Blue Cross and Blue Shield
Process and resolve medical claims that require manual adjudication for Arkansas Blue Cross and Blue Shield. Investigate processing issues, interpret benefits, verify eligibility, and maintain accurate claim decisions.
Description
- Manually resolve medical claims that the automated processing system cannot adjudicate
- Investigate claim issues and communicate with relevant parties to collect missing information
- Record claim details accurately in the claims processing system
- Interpret contract provisions and applicable benefits
- Resolve claims edits and audit findings
- Assess whether services and claims meet benefit eligibility requirements
- Research processing problems using system resources and official manuals
- Refer claims to the appropriate internal teams
- Coordinate with internal employees and medical providers
- Prepare and issue claim-related correspondence
- Complete information-request forms as needed
- Participate in initial training, on-the-job instruction, and continuing education
- Use applicable computer systems and screens to process claims accurately
- Keep current with procedural, benefit, and system changes
- Meet corporate and national MTM productivity and quality standards
- Use corporate and professional reference materials, including processing manuals and ICD, CPT, and HCPCS codebooks
- Handle additional duties as assigned
Requirements
- High school diploma or equivalent
- At least two years of college coursework, totaling 48 semester hours, or equivalent certification focused on anatomy, medical terminology, mathematics, biology, or a related discipline; alternatively, at least one year of related office experience in claims processing, health insurance, or a medical office
- Successful completion of the company Claims Assessment proficiency test
- Effective oral and written communication
- Strong interpersonal abilities
- Sound professional judgment
- Effective decision-making
- Careful attention to detail
- Ability to work collaboratively
- Reliable and dependable work habits
- Ability to protect the security and confidentiality of records and information
- Compliance with segregation-of-duties requirements in the Administrative Manual