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Senior Claims Examiner AHA at Independence Blue Cross LLC in Minneapolis, Minnesota

Posted in General Business 30+ days ago.

This job brought to you by eQuest

Type: Full-Time





Job Description:

Bring your drive for excellence, team orientation
and customer commitment to AHA; help us renew and reimagine our business and
shape the future of health care.  Our organization is looking to
diversify, grow, innovate and serve, and we are looking for committed,
empowered learning-oriented people to join our team.  If this describes
you, we want to speak with you.

 

Responsibilities:


·      
Responsible for accurate and timely handling of
claim and adjustment processing for both local and Blue card claims.


·      
Applies and maintains comprehensive knowledge of
claims processing and support systems. 


·      
Research and finalize complex and/or high dollar
claims and adjustment requests received from all areas, inclusive of internal
and external sources (e.g. other plans and providers.) 


·      
Meet departmental quality and production
requirements.


·      
Respond following departmental standard
professionally to external/internal inquiries, as appropriate, while
maintaining corporate and departmental standards.


·      
Report observed trends of continuous claim
errors/problems for corrective interventions.


·      
Analyze, scope and work claim projects. 


·      
Assist claims associates with questions, provide
direction to staff and support training as needed.


·      
Participate on task teams related to claims or
adjustment efficiencies and methodologies.


·      
Identify opportunities for claims related process
improvement.


·      
Perform other duties as necessary.


Qualifications:


·      
High
School graduate or equivalent work experience.


·      
2+
proven work experience in a production environment.


·      
Demonstrated
math and comprehension skills required.


·      
Good
interpersonal skills for handling internal and external customers.


·      
Well-developed
listening, verbal and written communication skills.


·      
Proficiency
with Microsoft Office specifically Excel and Word is required.


·      
Ability
to research and investigate information using multiple sources, operating systems
and documented guidelines.


·      
Knowledge
of claims processing systems (membership, provider, adjustments)


·      
Experience
working with providers and members preferred


·      
Ability
to accurately perform research analysis, determine root cause and determine
appropriate action


·      
Must
have strong organizational skills and problem-solving ability. 


·      
Must
be detail-oriented