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Claims Processor

Claims Processor

Blue Cross Blue Shield of ArizonaPhoenix, AZ
30+ days ago
Job type
  • Full-time
Job description

Job Description

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

This position requires work and residency in the state of Arizona.

Blue Cross Blue Shield of Arizona (BCBSAZ) is immediately hiring a full-time Claims Processor to help inspire a healthier Arizona. As our Claims Processor, you will come alongside our Reimbursement Services department to adjudicate incoming claims in accordance with policies, procedures, guidelines, regulatory requirements, and contractual agreements.

As you do, you’ll thrive in an energetic, diverse environment, championed by an organization consistently named a Best Places to Work and Most Admired Company in Arizona.

Inspiring Health in Arizona Starts with You

Our benefits support work-life balance and the flexibility you need to be your best.

They include :

Eleven paid holidays, including a floating holiday you can use any time you wish

Accrued paid time off (up to 18 days per calendar year)

Comprehensive medical, dental, and vision coverage

k) up to 5% dollar-per-dollar match, 2% non-elective employer contribution

Eight paid volunteer hours to support our mission of inspiring health

Tuition reimbursement for you; scholarship opportunities for your children

Employee discounts, gym reimbursement, and wellness programs

Treadmill desks, full-service fitness center, onsite cafeterias

Ongoing training for employees who wish to grow in their careers, acquire skills, and become managers

To thrive in this job, you must be able to :

  • Maintain confidentiality and privacy
  • Compose and dictate a variety of business correspondence
  • Interpret and translate policies, procedures, programs, and guidelines
  • Perform investigative and analytical research
  • Maintain production and quality standards to help ensure claims are processed correctly the first time
  • Navigate, gather, input, and maintain data records in multiple system applications
  • Follow and accept instruction and direction
  • Establish and maintain working relationships in a collaborative team environment

Responsibilities

Adjudicate claims according to regulatory, contractual and health plan requirements

Pre-screen accuracy of EDI submissions through review of data elements in claims system

Verify a claim is not a duplicate of a previously submitted claim

Keep updated with processing manual and other educational / training materials

Know and adjudicate claims according to COB provisions

Identify and refer TPL issues to appropriate department

Identify and refer medical review claims to appropriate department

Identify and refer potential FWA claims to appropriate department

Identify opportunities for provider education

Identify opportunities for process improvement, including auto adjudication

Qualifications

High school diploma or GED (required)

Associate degree in a general field of study (preferred)

At least one year of prior work experience

Experience with claims processing, including UB, , and dental

BPT / HCPC and ICD10 coding skills

Knowledge of Medicaid and Medicare

Intermediate PC proficiency, including the ability to type at least 30 words per minute with 95% accuracy

Why Join Blue Cross Blue Shield of Arizona?

At BCBSAZ, your pursuit of balance, happiness, and fulfillment is supported through our Workability model. Workability is our workforce strategy and defines where and how we do our jobs.

Our award-winning healthy campus in Phoenix is always available to you. Access telehealth services at our BlueCare Anywhere kiosk, fuel up with healthy meals and snacks at our Work Perks Café, and make the most of our onsite fitness center by taking advantage of personal trainers, a nutritionist, Health Support programs, and daily group fitness classes, including spin, yoga, and Zumba.