Claims Research Associate

Blue Cross And Blue Shield Of Alabama - Birmingham, AL

Full-time - Entry Level

Birmingham, AL

Insurance Carriers and Related Activities

About the position

The Claims Research Associate position at Blue Cross and Blue Shield of Alabama focuses on medical claims processing and inquiry resolution. The role involves reviewing claims for errors, ensuring compliance with business regulations, and communicating with various departments to resolve customer inquiries. The position includes a structured training program designed to equip associates with the necessary skills for effective claims management.

Responsibilities

• Process medical claims according to business regulations and internal standards.
• Resolve inquiries within accuracy and timeliness goals specific to customer contract agreements.
• Review claims for errors and compare member benefits to services requested.
• Perform analysis of claims and make necessary updates, including recalculating benefits for previously processed claims.
• Reject or redirect misrouted claims and ask clarifying questions when information is incomplete or inaccurate.
• Communicate via inquiry, email, and telecommunication across multiple areas of the company to ensure customer resolution is complete.

Requirements

• High school diploma or GED required.
• Experience interacting with customers.
• Problem-solving and analytical skills.
• Time management and organizational skills to prioritize tasks.
• Research skills using a computer and/or reference materials.
• Strong communication skills for interpreting and documenting information.

Nice-to-haves

• Bachelor's degree preferred.
• Experience in a position with production, accuracy, and/or timeliness requirements preferred.
• Experience adjusting and adapting to necessary changes due to business needs preferred.
• Claims coding and ICD knowledge preferred.

Benefits

• Full-time position with competitive hourly pay.
• Structured training program with multiple phases.
• Potential for remote/hybrid work after training completion.