Summary
 

Functions as work leader for a claims customer service unit responsible for resolving customer inquiries and performing initial claims adjudication or non-medical appeals review. Assists with escalated and complex issues.

Description
 

What You’ll Do:

• Distributes daily work to employees, tracks workload and employee performance, and makes appropriate decisions necessary to ensure all processing expectations and team goals are met.
• Responds accurately and timely to inquiries from team members, including management, concerning customer inquiries, claims adjudication, appeals and other technical issues.
• Investigates and initiates resolutions to complex problems.
• Authorizes payment recovery, claim payments, or makes claim rejections based on documented information and provisions of state or federal law.
• Identifies issues with procedures and processes and provides feedback to management on changes and development.
• Trains new employees and introduces new material to all employees.
• Develops, updates, and maintains procedural manuals.
• Serves as liaison with other departments to address claim, system and quality issues.
• May perform some testing functions and attend/participate in meetings as needed.

                      

To Qualify for This Position, You’ll Need:

• High School Diploma or equivalent
• 3 years of customer service experience and 1 year of claims or appeals processing experience OR Bachelor’s Degree in lieu of work experience.
• Excellent verbal and written communication skills.
• Strong customer service skills.
• Proficient spelling, punctuation, grammar, and basic business math.
• Ability to handle confidential or sensitive information with discretion.
• Knowledge of claims processing procedures.
• Experience with Microsoft Office.

What Blue Can Do For You:

Our comprehensive benefits package includes:

• 401(k) retirement savings plan with company match
• Subsidized health plans and free vision coverage
• Life insurance
• Paid annual leave — the longer you work here, the more you earn
• Nine paid holidays
• On-site cafeterias and fitness centers in major locations
• Wellness programs and a healthy lifestyle premium discount
• Tuition assistance
• Service recognition

What to Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications.  This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.  Management will be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.

 

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.