Claims Processor, Intermediate at Blue Shield of CA in Monterey Park, California

Job Description:

Job Summary

Responsible for processing work in Enrollment, Claims, Provider, or other operational area to meet operational, financial, and service requirements including timely and proper enrollment, adjudication of claims, or provider demographics updates in accordance with contractual requirements Claims Processor - Reviews and adjudicates complex/specialty paper/electronic claims. Determines whether to return, deny, or pay claims following organizational policies and procedures. May provide guidance or expertise to less experienced claims processors.

Responsibilities

• Experienced in back-end processing; proficient in resolving complex edits using available documents/job aids with minimum direction


• May experience front-end processing and difficult adjustments


• Given special processing assignments; coordinates with other departments for resolution if needed


• Understands fundamentals of end-to-end (life of a clam) claims processing


• Consistently performs established performance metrics


• Consistently performs other duties/assignments as needed

Knowledge and Experience

• Strong knowledge of Claims


• Requires basic job knowledge of systems and procedures obtained through prior work experience or education


• In-depth knowledge of Blue Shield of California's mission, vision and strategy and healthcare industry environment


• Intermediate-Advanced skills creating documents/files using Excel, Outlook, Power Point, and Word


• Typically, requires minimum of 3 years of experience


• 1-3 years Medi-Cal experience strongly preferred


• May require vocational or technical education in addition to prior work experience

Additional Information

• About Company: At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. We're excited to share Blue Shield of California has received awards and recognition for - LGBT diversity, quality improvement, most influential women in corporate America, Bay Area's top companies in volunteering & giving, and one of the world's most ethical companies. Here at Blue Shield of California, we're striving to make a positive change across our industry and the communities we live in - Join us!










• Physical Requirements: Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
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• EEO Footer: External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.











• Requisition ID: 21001N3













• Posting Date: May 12, 2021











• Schedule: Full-time

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