„Blue Cross NC“ yra sveikatos draudimo bendrovė, teikianti sveikatos draudimo planus ir susijusias paslaugas asmenims bei grupėms. Jos veiklos pagrindą sudaro pagalba nariams gauti sveikatos priežiūros draudimą, geresnių sveikatos rezultatų skatinimas pasitelkiant sveikatos programas ir paslaugas bei indėlis į aptarnaujamų bendruomenių gerovę.
Health Insurance Claims Specialist – North Carolina Remote
Adjudicate moderate to complex health insurance claims for Blue Cross NC in a remote North Carolina role. Manage resolutions, compliance, provider inquiries, payment accuracy, and claims-process improvements.
Aprašymas
- Adjudicate claims promptly according to contractual benefits and healthcare policies
- Manage daily work queues, processing quality, and final claim resolution
- Track turnaround times against compliance requirements and performance guarantees
- Process, adjust, and correct payments for moderate to complex claims
- Answer payment inquiries from customer service teams, subscribers, providers, physicians, and other insurers
- Achieve established quality and productivity targets
- Resolve suspended claims by reviewing eligibility, claims history, and related information
- Refer claims requiring specialized handling to subject matter experts
- Identify system problems, propose solutions, and route issues to technical teams
- Collaborate with Provider Services specialists to deliver tailored support
- Screen claims for potential fraud or abuse and refer them to the Special Investigations Unit
- Improve efficiency and output through continuous improvement and claims expertise
- Coordinate with other insurers and Medicare to establish BCBSNC payment responsibility
- Represent Claims on divisional and enterprise project teams
Reikalavimai
- High school diploma or GED
- At least three years of experience in a related field
- Blue Cross NC does not sponsor employment authorization for this position
- Experience with health insurance claims is a plus
- Experience with Facets claims is a plus
Privalumai
- Medical, dental, and vision coverage
- Health and wellness programs
- Parental leave and support
- Adoption and surrogacy assistance
- Career development programs
- Tuition reimbursement for continuing education
- 401(k) matching with an annual company contribution
- Paid time off
- Annual incentive bonus
- Work-life balance, flexibility, and autonomy
- Remote work with a few in-office visits each year for meaningful moments