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Arkansas Blue Cross and Blue Shield
Arkansas Blue Cross and Blue Shield
1.001 – 5.000 Angajați
Asigurare de sănătateAsigurăriAsistență medicală

Arkansas Blue Cross and Blue Shield este un licențiat independent al Blue Cross and Blue Shield Association și oferă asigurări de sănătate în toate cele 75 de comitate ale statului Arkansas. Oferta sa include acoperire pentru persoane fizice și familii, planuri Medicare și Medigap, asigurări stomatologice și oftalmologice, planuri de asigurare medicală pentru călătorii și acoperire de grup sponsorizată de angajatori.

Compania își sprijină, de asemenea, membrii prin portalul Blueprint, care reunește instrumente pentru gestionarea planurilor de sănătate, verificarea cererilor de despăgubire, găsirea furnizorilor de servicii medicale și estimarea costurilor tratamentului. Activitatea sa acoperă servicii de asigurări de sănătate, asistență pentru membri și administrarea digitală a planurilor de sănătate.

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Locurile de muncă ale companiei

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.

USStatele Unite ale Americii
19 $ – 25 $ / oră
RemoteNormă întreagăJuniorNu este necesară o diplomăLimbă Obligatorie: englezăSpecialist în daune

Descriere

  • 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

Cerințe

  • 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

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