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Arkansas Blue Cross and Blue Shield
Arkansas Blue Cross and Blue Shield
1001 – 5000 Zaposleni
ZavarovanjeZdravstveno varstvoZdravstveno zavarovanje

Arkansas Blue Cross and Blue Shield je neodvisni imetnik licence združenja Blue Cross and Blue Shield Association, ki zagotavlja zdravstveno zavarovanje v vseh 75 okrožjih Arkansasa. Njegova ponudba vključuje individualno in družinsko kritje, načrte Medicare in Medigap, zobozdravstveno zavarovanje ter zavarovanje vida, potovalne zdravstvene načrte in skupinsko kritje za delodajalce.

Podjetje člane podpira tudi prek portala Blueprint, ki združuje orodja za upravljanje zdravstvenih načrtov, pregled zahtevkov, iskanje izvajalcev zdravstvenih storitev in ocenjevanje stroškov zdravljenja. Njegovo delo zajema storitve zdravstvenega zavarovanja, podporo članom in digitalno upravljanje zdravstvenih načrtov.

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Delovna mesta v podjetju

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.

USZdružene države AmerikeIDIdahoNDSeverna DakotaOROregonUTUtahWAWashington
19 $ – 25 $ / ura
Na daljavoPolni delovni časJuniorDiploma ni potrebnaZahtevani Jezik: angleščinaSpecialist za obravnavo škod

Opis

  • 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.

Zahteve

  • 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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