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Claims Specialist
Arkansas Blue Cross and Blue ShieldClaims Specialist resolving pended medical claims for Arkansas Blue Cross, a health insurer. Investigating eligibility, benefits, processing issues, and required documentation accurately.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in medical claims processing, including investigation, data entry, and benefit eligibility determination. Proficient in maintaining confidentiality and adhering to segregation-of-duties guidelines while ensuring compliance with corporate and national standards.
Highest-signal resume keywords
Claims ProcessingMedical TerminologyOral And Written Communication SkillsDetail-OrientedCustomer Service
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims AssessmentData EntryBenefit Eligibility DeterminationEdit And Audit ResolutionResearchingEvaluating InformationProcessing InformationReading ComprehensionComputer WorkCritical Thinking
Soft Skills
Interpersonal SkillsSound JudgmentDecision-Making AbilityTeamworkDependability
Certifications & Qualifications
High School Diploma Or EquivalentMinimum Two Years' College Coursework
Industry Keywords
Medical ClaimsHealth InsuranceAnatomyBiologyConfidentialitySegregation-Of-Duties Guidelines
About the role
Key responsibilities & impact- Resolve medical claims that are not automatically adjudicated by the claims processing system
- Investigate claims and communicate to obtain necessary information for claim completion
- Enter claim data into the system
- Review and interpret contract benefits
- Conduct edit and audit resolution
- Determine benefit eligibility
- Identify and research processing issues using systems and manuals
- Route claims to other areas
- Consult internal staff and medical providers
- Generate correspondence and complete forms
- Complete initial, on-the-job, and continuing training
- Access relevant computer systems and screens to process claims accurately
- Stay current with changing processing procedures, benefits, and system modifications
- Meet corporate and national MTM standards while maintaining departmental productivity and quality standards
- Perform other duties as assigned
- Maintain security and confidentiality of records and information
- Adhere to segregation-of-duties guidelines
Requirements
What you’ll need- High School diploma or equivalent
- Minimum two (2) years' college coursework (48 semester hours) or other equivalent certification with 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
- Oral and written communication skills
- Strong interpersonal skills
- Sound judgment
- Decision-making ability
- Detail-oriented
- Teamwork
- Dependability
- Clinical judgment
- Computer work
- Critical thinking
- Customer service
- Evaluating information
- Organizing
- Processing information
- Reading comprehension
- Researching
- Time management
- Ability to maintain security and confidentiality of records and information
- Ability to adhere to segregation-of-duties guidelines
Benefits
Comp & perks- Tuition reimbursement
- Club Blue, a free, onsite gym
- Green Leaf Grill and Green Leaf Grill Express, onsite restaurants promoting healthy eating
- Incentives for wellness education and exercise
- Inclusive culture and employee connection activities
- Community volunteer opportunities