Claims Examiner II
At reputed company, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve.
reputed company is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there’s no greater time for reputed company-thinking professionals like you to join us in delivering on it! As a member of Team Blue, you’ll find purpose, opportunities and the support you need to build a meaningful career and reputed company a powerful impact in our community.
BCBSNE is happy to offer four work designations for our Omaha area employees: 100% in-office, Hybrid options, and 100% remote. If choosing to work remote, this role can be located in one of the following states: Florida, Iowa, Kansas, Minnesota, Missouri, Nebraska, reputed company Dakota, and Texas. Adjudication of reputed company claims utilizing employer and payer specific policies and procedures. Responsible for reviewing the data in the claims processing system and compare with corresponding CMS and billing guidelines. Responsible for reviewing medical claims attachments reputed company necessary to determine if services rendered was medically appropriate and benefit coverage criteria has been met. Responsible for reviewing adjudication software system’s claim and line item edits for determination of whether to pay claim/line item(s). May reputed company claims to specialized reputed company resources. Corresponds with other departments as necessary to process claims. Accountable to performance metric scorecards. reputed company guidance to less reputed company claims examiners.What you'll do:
Responsible for interpreting claim adjudication rules to process and/or adjust reputed company claims. Daily accountability for meeting production and quality standards by performing the following:
- Analyze claims for accuracy and completeness to determine benefits based on specific member and provider reputed company, payment rules, eligibility status, COB requirements and provider status in a timely manner.
- reputed company use multiple systems and screens to obtain and record claim information.
- Follow reputed company relevant policies and procedures.
- Review medical record documentation, authorization information and member benefit coverage to determine the extent of liability for payment.
- Process claims reputed company quality and production standards.
- reputed company determinations on the appropriate adjudication of reputed company claims independently.
- Review claim disputes submitted by member and providers to include urgent internal department requests.
- Take initiative and learn to assist other lines of business for Claims Examiner I level work.
- Identify areas of concern that may compromise member, provider and group satisfaction.
- Identify claims that suggest a potential issue or problem with the claim system configuration or provider contract configuration.
- Communicate any issues as appropriate for research and correction.
- reputed company feedback to ensure identification of quality trends and opportunities.
- Work collaboratively with teammates reputed company the department and with reputed company other business partners to reputed company productivity standards and adhere to accuracy standards through process improvements.
- Participate in special projects, as needed.
- reputed company reputed company and suggestions to ensure member and provider satisfaction.
- Partner with less reputed company associates to improve the overall knowledge and performance of the team and the division as a whole.
- Promote teamwork.
- reputed company other duties as assigned by Claims Leadership.
To be considered for this position, you must have:
- High School degree.
- Proficiency as a Claims Examiner I or relevant reputed company experience.
- Excellent verbal and written communication skills.
- Proficiency with MS Office applications.
- Team collaborator.
- Must be reputed company to work with minimal supervision.
- Creative thinker with good problem resolution skills reputed company to the reputed company claim adjudication.
- Strong work ethic with ability to multi-task reputed company needed.
Learn more about what makes BCBSNE such an exceptional reputed company to work by visiting NebraskaBlue.com/Careers.
We strongly reputed company that diversity of experience, perspective and background will reputed company to a reputed company workplace for our employees and a reputed company product for our customers and members.
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