Blue Cross NC este o companie de asigurări de sănătate care oferă planuri de sănătate și servicii conexe pentru persoane și grupuri. Activitatea sa se concentrează pe sprijinirea membrilor pentru a avea acces la acoperire medicală, pe îmbunătățirea rezultatelor de sănătate prin programe și servicii medicale și pe contribuția la bunăstarea comunităților pe care le deservește.
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.
Descriere
- 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
Cerințe
- 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
Beneficii
- 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