Job Information
Blue Cross Blue Shield Claims Processor in Marion, Illinois
This job was posted by https://illinoisjoblink.illinois.gov : For more information, please see: https://illinoisjoblink.illinois.gov/jobs/12179196
At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.
Come join us and be part of a purpose driven company who is invested in your future!
Job Summary
Under supervision this position is responsible for processing claims requiring investigation, phone calls, accessing resource materials and several support files; screening and editing claims data for accuracy; and processing for adjudication.
Responsibilities
CLAIMS, CLAIMS, CLAIMS
- Process claims in various queues. Conduct research and investigation into missing information, make phone calls to providers, access resource materials and support files in order to process and adjudicate claims timely and accurately.
- Resolve claim edits.
- Review Business Process Outsourcing Standard (BPO) Claim forms (CMS 1500 and UB04) for missing, incorrect or editing issues.
- Review BPO Loose Bills and Major Medicals and process specific to current processing guidelines.
- Review and transfer applicable dollars amounts for other Insurance attachments to capture Deductible, Allowed and Reasonable amounts from the Explanation of Benefits.
- Utilize CFE and Blue Chip support files.
- May be required to prepare and/or work form routine reports.
Required Job Qualifications:
- High School diploma or GED.
- Data entry and/or typing experience.
- Clear and concise verbal, written and interpersonal skills.
\ Preferred Job Qualifications:
- 1 year insurance experience.
- 6 months data entry experience working in a high volume production setting.
- Knowledge of medical terminology and anatomy
- PC proficiency to include Microsoft Word, Excel and Lotus Notes.
- Referral preference given to applicants able to take and meet testing criteria.
- Prior completion of the three-eight week CFE or BlueChip claims processing training, or have the ability to fully complete the three-eight weeks CFE/BlueChip Training class.
- Knowledge of medical terminology and CPT, HCPCS and ICD9/10 coding.