Claims Examiner
Blue Cross and Blue Shield of Kansas
full-time
Posted on:
Location Type: Hybrid
Location: Topeka • Kansas • Montana • United States
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Salary
💰 $21 - $26 per hour
About the role
- A health claims examiner is responsible for reviewing, evaluating, and processing health, drug, dental and/or ancillary product claims submitted by members or providers for insurance reimbursement.
- Claims review and verification: Accurately review, analyze, and verify healthcare claims submitted by policyholders or medical providers.
- Ensure all necessary documentation, coding (ICD-10, CPT, HCPCS), and data are included and correct.
- Check for eligibility, coverage, and applicable benefits as per policy terms.
- Claims Processing: Enter and process claims information into the system with precision and attention to detail.
- Apply appropriate insurance guidelines, including deductibles, co-pays, co-insurance, and maximum coverage limits.
- Approve or deny claims based on policy coverage, ensuring compliance with regulatory and company standards.
- Perform adjustments to processed claims as needed for corrective action.
- Correspond with healthcare providers, patients, and internal departments to clarify or resolve discrepancies.
- Investigate and resolve complex or escalated claim issues, such as coding errors, benefit misunderstandings, or billing discrepancies.
- Ensure compliance with state and federal healthcare regulations.
- Maintain detailed and accurate records of all claims processed, including documentation for audits or reviews.
- Meet individual and team performance targets related to claims processing speed, accuracy, and quality.
- Participate in ongoing training to stay updated on changes in health insurance policies and claims processing technologies.
Requirements
- High school diploma or equivalent required
- Previous experience in healthcare claims processing, medical billing, medical terminology, or health insurance is preferred.
- Strong attention to detail and organizational skills.
- Knowledge of medical claim processing, medical terminology, insurance policies, and coding standards (ICD, CPT).
- Excellent communication skills, both written and verbal.
- Ability to work efficiently under pressure and meet deadlines.
- Critical thinking and problem solving skills.
Benefits
- Incentive pay program (EPIP)
- Health/Vision/Dental insurance
- 6 weeks paid parental leave for new mothers and fathers
- Fertility/Adoption assistance
- 2 weeks paid caregiver leave
- 401(k) plan matching up to 5%
- Tuition reimbursement
- Health & fitness benefits, discounts and resources
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
health claims processingmedical billingmedical terminologyICD-10CPTHCPCSclaims reviewclaims verificationdata entryclaims adjustments
Soft Skills
attention to detailorganizational skillscommunication skillscritical thinkingproblem solvingability to work under pressuretime managementteamworkadaptabilitycustomer service
Certifications
high school diploma or equivalent