Under supervision, this role processes complex healthcare claims that require further investigation, including coordination of benefits and resolution of pended claims. The Claims Technician reviews, processes, and adjudicates claims accurately and efficiently in accordance with company policies, payer guidelines, and regulatory requirements.
The position investigates claim discrepancies, researches denials, verifies member and provider information, and works to ensure timely claim resolution. It also collaborates with internal departments, providers, and members to resolve claim issues while maintaining high standards of accuracy, productivity, compliance, and customer service.
This role includes mandatory onsite training for 13 weeks, Monday through Friday from 8:00 a.m. to 4:30 p.m. After successful completion of training, remote work provisions will be established. There may also be a need to return onsite for training up to 18 months at a designated Customer Service Hub.
High school diploma or GED.
- Strong data entry and/or typing experience
- Experience processing medical claims
- PC experience, including Windows and Microsoft Office
- Strong attention to detail, problem-solving, and organizational skills
- Clear and concise verbal and written communication skills
Preferred qualifications:
- Experience with the Blue Chip claims processing system, or ability to complete Blue Chip training
- Knowledge of medical terminology and CPT, HCPCS, and ICD-9 coding
- Knowledge of coordination of benefits principles and terminology
- Experience multitasking and prioritizing
- Familiarity with claims adjudication systems and healthcare payer processes
- Experience with BlueCard Medical Records and BlueCard Adjustment requests and responses
Location
Illinois, US
Employment Type
Full-time
Experience Level
Entry Level
Remote work allowed
Yes
Posted
1 month ago