Claims Examiner - Senior Care
BlueCross BlueShield of Tennessee - Chattanooga, TN

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General Summary

This position is responsible for processing claims for a variety of products in an accurate and timely manner. In addition, this position generates daily reports and is responsible for other duties assigned by the supervisor. This position can progress to Claim Expert (5009) based on competencies.

Job Duties & Responsibilities

Adjudicate all claims to completion or returns to provider or member for additional or missing information

Process claims accurately and timely in support of MTM or other performance measures

Handle all claim edits appropriately including possible duplicates, eligibility status, corrected bills, manual pricing when appropriate, provider screen messages, authorizations, pre-existing condition, big bill guidelines, etc.

Administer benefits according to Benefit Summary and or Online Help (OLH) processing guidelines

If necessary, route problem claims to TTE, Supervisor, CARR, UM or Case Management, COB, Subrogation Unit, etc.

Compile processed claims in a processed folder with processor number and date in the secure paid claims department file for verification, quality and records storage when appropriate

Ensure timely and accurate completion of daily/weekly reports

Stay up-to-date regarding online resources, such as Online Help, BlueAlert, Medical Policy, and all other electronic resource changes when applicable

Keep abreast of changing divisional guidelines and government regulations

Recognize cause of problem and effect of resolution

Perform miscellaneous projects as assigned

Work overtime as required

Qualifications

Education

High School Diploma or equivalent required

Experience

Claims processing and/or customer service experience preferred

If current employee with the company, must meet minimum performance expectations

Previous health care experience is preferred

Skills/Certifications

Microsoft Office products knowledge desired

Effective oral communication and interpersonal skills

Good written communication skills

Sound decision-making and problem-solving skills

Exceptional organizational and time management skills

Must be able to key 6500 keystrokes per hour with less then 10% error rate

BlueCross BlueShield of Tennessee - 23 months ago - save job - copy to clipboard
About this company
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BlueCross BlueShield of Tennessee (BCBST) is the oldest and largest not-for-profit managed care provider in the state of Tennessee....