What are the responsibilities and job description for the Claims Processor, Specialist position at Blue Shield of CA?
Your Role
The Medi-Cal Operations team is responsible for ensuring claims are processed accurately and timely. The Claims Processor, Specialist will report to the Medi-Cal Operations Supervisor. In this role you will be responsible for interfacing with other departments and vendors involved in the Claims process and will also serve as the primary point of contact for priority claim cases.
Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
Your Knowledge and Experience
Requires a high school diploma or GED
Requires at least 7 years of experience
Minimum of 3 years of experience in claims processing and/or auditing experience in a manage care setting required
Experience examining multiple claim types in the Medi-Cal/Medicare environment preferred
Knowledge of medical claims regulatory guidelines such as AB1455 and Medicare preferred
Proficiency in Microsoft Office programs such as Excel, Word and Outlook required
Hybrid Virtual Work
This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.