Non-Exempt/Bargaining Unit Posting

Date Posted: 01/19/2023

Date Closed: 01/26/2023

Local/Seniority Unit – 1781/3204

Department – 127100 Instate Claims Operations

Salary Grade – UJ

Number of openings – Multiple

Shift – Mon-Fri Flex shift 6a-830a start

Site/Location: RenCen - Tower 600

Status – Regular Full Time

• Enter claims into the claims processing system.
• Review and process original claims and adjustments, COB, and supplemental claims according to corporate and departmental policies, procedures and other guidelines while adhering to quality and productivity standards.
• Interpret benefits and calculate appropriate payment and member/provider liability as necessary according to applicable policies and procedures and guidelines.
• Utilize various online processing systems to adjudicate claims.
• Notify leadership of system problems or possible fraud situations.
• Process/finalize all instate claim types.

QUALIFICATIONS

• High School Diploma or GED required. Associate’s or Bachelor’s degree in Health Care or related field preferred.
• One year of claims processing/claims resolution experience on an automated claims processing system to have included strong knowledge and use of CPT/ICD codes and standard health claim billing forms (UB-04, CMS1500).
• OR Two years of claims related experience or provider billing/coding experience, which included significant use and application of CPT/ICD codes and standard health industry claim billing forms (UB-04, CMS 1500) or 3 years of experience at BCBSM in any Claims or Customer Service position. Must be able to demonstrate knowledge of medical terminology, coding, billing and claims processing obtained through work experience and/or completion of relevant claims or billing coursework.
• OR Associate’s or bachelor’s degree in health care claims or billing which included significant coursework and demonstrated knowledge of CPT and ICD coding, standard billing forms and medical terminology may be accepted in lieu of actual claims processing experience.
• Verbal and written communication skills required to obtain information and prepare general correspondence.
• Math skills required to calculate payment amounts.
• Analytical skills necessary for benefit interpretation and application.
• Knowledge of general office procedures and ability to operate basic PC software and keyboarding skills.
• Knowledge of medical claims, benefits/contracts and claim processing policies and procedures, as identified by line of business.
• Ability to access and interpret benefit files and benefit displays via computer terminal.
• Successful completion of Entry Level Pricer Assessment.
• Ability to utilize online desk level processing procedures.