Job Description
Note: The job is a remote job and is open to candidates in USA. CareFirst BlueCross BlueShield is seeking a Claims Processor I to review and adjudicate paper/electronic claims under direct supervision. The role involves examining non-adjudicated claims, ensuring accurate processing according to policies, and collaborating with multiple departments to resolve issues. Responsibilities Examines and resolves non-adjudicated claims to identify key elements of processing requirements based on contracts, policies and procedures Process product or system-specific claims to ensure timely payments are generated and calculate deductibles and maximums as well as research and resolve pending claims Completes research of procedures Applies training materials, correspondence and medical policies to ensure claims are processed accurately Partners with Quality team for clarity on procedures and/or difficult claims and receives coaching from leadership Required participation in ongoing developmental training to performing daily functions Completes productivity daily data that is used by leadership to compile performance statistics Reports are used by management to plan for scheduling, quality improvement initiatives, workflow design and financial planning, etc Collaborates with multiple departments providing feedback and resolving issues and answering basic processing questions Skills High School Diploma or GED Less than one year experience processing claim documents Demonstrated analytical skills Demonstrated reading comprehension and ability to follow directions provided Basic written/oral communication skills Demonstrated ability to navigate computer applications Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging Less than one year claims processing, billing, or medical terminology experience Benefits Comprehensive benefits package Various incentive programs/plans 401k contribution programs/plans Company Overview CareFirst. It’s not just our name. It’s our promise. It was founded in 1934, and is headquartered in Baltimore, Maryland, USA, with a workforce of 5001-10000 employees. Its website is