Claims Specialist I

Job Summary

To support the claims unit, the full-time Claims Specialist I will process claims edits, determine primacy for Coordination of Benefits (COB), and adjust previously paid claims while working remotely.

Key responsibilities

• Review and update claims, recalculating benefits and processing edits to ensure accuracy and customer satisfaction
• Communicate with internal and external contacts to gather necessary information for claims processing and maintain sound claim records
• Research and determine the correct order of benefits for payment, making necessary corrections to COB records

Required qualifications

• High School Diploma or equivalent required
• 6 months of experience in medical claims or health insurance-related customer service, or completion of BCBSLA adjustment or COB training
• Certification in Medical Billing or Coding can substitute for experience
• Strong analytical skills and working knowledge of relevant PC software