Claims Processor, Intermediate (ITS Host & Home)

Your Role 

The ITS Host and Home Claims teams process claims and adjustments for out of state Blue Cross Blue Shield members that receive services in California and for our Blue Shield of California members that receive services performed outside of California. The Claims Processor Intermediate will report to the Operations Supervisor. In this role you will be responsible for reviewing and adjudicating claims and/or adjustments in accordance with provider contracts and organizational policies and procedures to meet operational, financial, and service requirements.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Work 

In this role, you will: 

• Be experienced in back-end processing; proficient in resolving complex edits using available documents/job aids with minimum direction.
• Experience front-end processing and difficult adjustments.
• Be given special processing assignments; coordinate with other departments for resolution if needed.
• Understand fundamentals of end-to-end (life of a clam) claims processing 
• Perform established performance metrics.

Your Knowledge and Experience 

• Requires a high school diploma or GED
• Requires at least 3 years of experience
• Healthcare claims knowledge preferred, but not required
• Healthcare operations or customer service experience preferred
• Requires good communication skills both written and verbally 
• Requires the ability to make and receive phone calls both internally and externally while providing excellent customer service. 

 

Hybrid Virtual Work

This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.