Claims Specialist 1 - Cheyenne, United States - Blue Cross Blue Shield of Wyoming

    Blue Cross Blue Shield of Wyoming
    Blue Cross Blue Shield of Wyoming Cheyenne, United States

    1 month ago

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    Description
    Job Description Summary:
    To enter, review and verify online entry, work suspensions, and ensure final adjudication of paper/electronic claims. Claims Specialist 1 must demonstrate competence and efficiency in one line of Business (LOCAL, FEP, BlueCard HOME or BlueCard HOST) and Front Entry (manual entry of paper claims submitted by members or providers).

    Job Description:

    JOB SUMMARY

    To enter, review and verify online entry, work suspensions, and ensure final adjudication of paper/electronic claims. Claims Specialist 1 must demonstrate competence and efficiency in one line of Business (LOCAL, FEP, BlueCard HOME or BlueCard HOST) and Front Entry (manual entry of paper claims submitted by members or providers).

    ESSENTIAL DUTIES & RESPONSIBILITIES
    • Upon receipt of claims, determine if claim information is complete and correct; enter and verify claims data entry.
    • As needed, resolve claim suspensions by reviewing historical records and determining benefit eligibility for services.
    • Review payment considerations to arrive at final payment determination.
    • Meets all production and quality standards.
    • Elevates issues to the next level of supervision, as appropriate.
    • Accomplishes the above tasks with the use and knowledge of the established computerized claims processing system.
    NON-ESSENTIAL DUTIES & RESPONSIBILITIES
    • Attends department/corporate meetings as necessary.
    • Other duties, responsibilities, and/or special projects as assigned.
    APPLICABLE KNOWLEDGE, SKILLS, & ABILITIES (KSA)
    • Ability to take direction and to navigate through multiple systems simultaneously.
    • Ability to use mathematics to key/process a claim.
    • Knowledge of operating systems specific to claims processing.
    • Email
    • Prior experience in health insurance preferred but not required.
    • Prior experience in data entry preferred but not required.
    QUALIFICATIONS
    • A minimum of a high school, or equivalent, education. The company will provide on-the-job training related to the processing of health insurance claims.
    PHYSICAL/MENTAL DEMANDS & WORK ENVIRONMENT

    While performing the essential duties of this position, an employee will typically experience:
    • Standing, walking, and sitting.
    • Lifting and/or moving up to 10 pounds; occasionally lifting and/or move up to 25 pounds short distances.
    • Usage of close vision, distance vision, and ability to adjust focus.
    • Manipulation of keyboards, keypads, and calculators.
    • Placing and answering telephone calls.
    • Focused task tracking and follow-through.
    • Some interpersonal tension in problem-solving/resolution interactions.
    • Speaking/presenting to internal and external audiences of diverse sizes.
    • Work environment noise level that is usually moderate.
    • Open office environment with few, if any, loud sounds, or ongoing auditory distractions.
    • Some deadline related stress.
    • As needed evening and weekend hours on a periodic basis.
    • Minimal travel, typically in-state.
    To perform successfully in this position, an individual must be able to perform essential duties satisfactorily as well as possess education/experience, knowledge, skill, and abilities (KSA) as listed in representative fashion; reasonable accommodations may be made to enable individuals with limitations/disabilities to perform the essential functions of this position. The essential duties and KSA listed are not all inclusive, but representative. Other duties may be assigned.