Claims Research Associate

Blue Cross And Blue Shield Of Alabama - Mountain Brook, AL

Full-time - Entry Level

Mountain Brook, 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 ensuring claims are processed accurately and timely according to business regulations and internal standards. The incumbent will analyze claims, make necessary updates, and communicate effectively across various departments to resolve customer inquiries. The position includes a structured training program designed to equip associates with the necessary skills for success in claims processing.

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, redirect misrouted claims, or 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 equivalent.
• 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 to interpret and communicate information both orally and in writing.

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 onsite training with potential for remote/hybrid schedules after training completion.