Blue Cross NC jismoniy shaxslar va guruhlar uchun tibbiy sug‘urta rejalari hamda tegishli xizmatlarni taqdim etuvchi tibbiy sug‘urta kompaniyasidir. Uning faoliyati a’zolarga tibbiy sug‘urta qamrovidan foydalanishga yordam berish, sog‘liqni saqlash dasturlari va xizmatlari orqali salomatlik natijalarini yaxshilashni qo‘llab-quvvatlash hamda xizmat ko‘rsatadigan jamoalar farovonligiga hissa qo‘shishga qaratilgan.
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.
Tavsif
- 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
Talablar
- 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
Imtiyozlar
- 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