13 Claims Specialist I Jobs in Little Rock, AR
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Arkansas Blue Cross Blue Shield is Hiring a Claims Specialist I Near Little Rock, AR
Arkansas Blue Cross is only seeking applicants for remote positions from the following states:
Arkansas, Florida, Georgia, Illinois, Kansas, Louisiana, Minnesota, Mississippi, Oklahoma, South Carolina, Tennessee, Texas, Virginia and Wisconsin.Workforce Scheduling
Remote
Job SummaryThe Claims Specialist resolves medical claims that are not automatically adjudicated by the claims processing system in a timely and accurate manner according to divisional standards of quality and productivity. Resolution may include additional investigation or communication in order to obtain necessary information to complete the claim. Outside issues such as peak filing season, systems down time, inclement weather, holidays, and absenteeism may directly affect the volume of work for each Specialist
RequirementsEDUCATIONHigh School diploma or equivalent.
ExperienceMinimum two (2) years' college coursework (48 semester hours) or other equivalent certification with an emphasis in anatomy, medical terminology, math, biology, or a related field. OR minimum one (1) year of related office experience such as claims processing, health insurance, or medical office.
Must pass company proficiency test: Claims Assessment
Essential Skills & AbilitiesOral & Written Communications
Strong Interpersonal skills
Sound Judgement
Decision Making
Detail-Oriented
Teamwork
Dependability
SkillsClinical Judgment, Decision Making, Detail-Oriented, Interpersonal Relationships, Oral Communications, Written Communication
ResponsibilitiesClaims Processing: Claims processing involves the actions required to pay or deny pended claims (those which did not auto-adjudicate), including: entering data into the system; reviewing and interpreting contract benefits; conducting edit and audit resolution; determining benefit eligibility; Identifying and researching processing issues through systems and manuals; routing claims to other areas; consulting internal staff and medical providers; generating correspondence; and completing forms to obtain necessary information, Knowledge/Continuous Learning: In order to perform the actions required of the Claim Specialist job, the incumbent must undergo initial training, on-the-job training, and continuing education. Demonstrating knowledge of and possessing the ability to access all relevant computer systems and screens in order to process claims accurately; staying current with continually changing processing procedures, benefits, and system modifications; being knowledgeable of and able to meet corporate and national (MTM) standards while maintaining acceptable performance levels based on established departmental standards for productivity and quality; and showing familiarity with corporate and professional manuals and guidebooks, including the company processing manual and ICD, CPT, and HCPS codebooks, Other duties: As assigned
Certifications
Security Requirements
This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual.
Segregation of Duties
Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual.
Employment Type
Regular
ADA Requirements1.1 General Office Worker, Sedentary, Campus Travel - Someone who normally works in an office setting or remotely and routinely travels for work within walking distance of location of primary work assignment.
Job Summary
Full Time
Insurance
$58k-70k (estimate)
10/19/2023
05/25/2024
arkansasbluecross.com
TEXARKANA, AR
1,000 - 3,000
1948
$1B - $3B
Insurance
Related Companies
About Arkansas Blue Cross Blue Shield
For 70 years, Arkansas Blue Cross and Blue Shield has been a trusted partner to Arkansans by providing reliable insurance plans while also being a valuable community partner. We live here, work here and raise our families here we are dedicated to Arkansas and to you. We work hard to improve the health, financial security and peace of mind to the members and communities we serve. Arkansas Blue Cross and Blue Shield is an Independent Licensee of the Blue Cross and Blue Shield Association.
The following is the career advancement route for Claims Specialist I positions, which can be used as a reference in future career path planning. As a Claims Specialist I, it can be promoted into senior positions as a Claims Adjuster II that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Claims Specialist I. You can explore the career advancement for a Claims Specialist I below and select your interested title to get hiring information.
If you are interested in becoming a Claims Specialist, you need to understand the job requirements and the detailed related responsibilities. Of course, a good educational background and an applicable major will also help in job hunting. Below are some tips on how to become a Claims Specialist for your reference.
Step 1: Understand the job description and responsibilities of an Accountant.
Quotes from people on Claims Specialist job description and responsibilities
The specialist reports and processes these claims by researching the policy and accumulating evidence regarding the claim.
02/21/2022: Benton Harbor, MI
Claims specialists must also compile reports and communicate regularly with supervisors and managers regarding the status of claims.
03/17/2022: Madison, WI
Claims Specialists are responsible for a wide range of administrative tasks related to the delivery of medical care.
03/13/2022: New Brunswick, NJ
Evaluates liability, coverage and settles claims within prescribed procedures and authority.
03/07/2022: Vallejo, CA
Reviews and evaluates property claims for coverage and further claim handling procedures to conclude within required statutory time frame.
03/03/2022: Provo, UT
Step 2: Knowing the best tips for becoming an Accountant can help you explore the needs of the position and prepare for the job-related knowledge well ahead of time.
Career tips from people on Claims Specialist jobs
Claims specialists are required to follow the California Health and Safety Code when accepting or denying claims.
02/04/2022: Lynchburg, VA
They must treat clients fairly and equitably, but also make sure claims are legitimate and reasonable.
03/03/2022: Portland, ME
They must know the details of claims verification, payment processing, dispute resolution and fraud detection.
02/14/2022: Hialeah, FL
A good claims specialist will take a proactive approach to their job.
02/21/2022: Helena, MT
Claims specialist positions require superb organization skills to keep track of financial documents.
03/26/2022: New Bedford, MA
Step 3: View the best colleges and universities for Claims Specialist.
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