Blue Cross Blue Shield - Flowood, MS
posted 3 months ago
Full-time
Onsite - Flowood, MS
Insurance Carriers and Related Activities
About the position
The Claims & Adjustment Specialist processes claims for both fully-insured and self-insured lines of business, ensuring accurate application of provider and benefit contract provisions. This role involves handling claim and adjustment requests from members and providers, requiring effective communication with various departments and partner plans. The specialist is tasked with meeting established timeliness and accuracy benchmarks while ensuring a high level of service for members.
Responsibilities
- Process claims for fully-insured and self-insured lines of business.
- Make logical decisions to ensure accurate application of provider and benefit contract provisions.
- Handle claim and adjustment requests from members and providers.
- Communicate effectively with other areas and partner plans.
- Achieve established timeliness and accuracy benchmarks.
- Ensure members experience and service expectations are met.
Requirements
- Bachelor's degree required.
- Good computer skills, including experience with Microsoft Office Suite.
- Logical thought process and critical thinking skills to interpret and apply contract benefits.
- Customer-focused and service-oriented mindset.
- Ability to work with a high degree of accuracy and attention to detail.
- Excellent organizational skills to prioritize tasks and meet benchmarks.
Benefits
- Comprehensive benefits package worth approximately one-third of salary compensation.
