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Claims Specialist III
Blue Cross and Blue Shield of LouisianaClaims Specialist III processing complex claims and ensuring compliance with COB and claims guidelines in Louisiana. Involved in investigations and providing customer service support.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in claims processing, including Coordination of Benefits (COB) and adjustments, while ensuring compliance with relevant laws and regulations. Strong analytical and communication skills are essential for resolving complex issues and supporting customer service.
Highest-signal resume keywords
Claims ProcessingCoordination Of Benefits (COB)Claims CodingAnalytical AbilityCommunication Skills
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 Edits ProcessingAdjustments ProcessingRecovery ProceduresProblem AnalysisSystem Changes DocumentationClaims Processing GuidelinesPrimacy Rules UnderstandingSelf-Funded Processing
Soft Skills
Strong Analytical AbilityExcellent Oral CommunicationExcellent Written CommunicationPrioritization Skills
Tools & Technologies
PC Software
Industry Keywords
ComplianceClaims Procedures
About the role
Key responsibilities & impact- Accurate processing of claims edits
- Determining primacy for the Coordination of Benefits (COB)
- Adjusting previously paid claims and initiating recovery procedures
- Analyzing, investigating, and resolving problem cases
- Assisting with developing, documenting, and testing system changes
- Providing direct support for Customer Service for complex issues
- Responsible for accurate and timely processing of complex regular adjustment requests
- Ensuring compliance with laws and regulations
Requirements
What you’ll need- High School Diploma or equivalent required
- 4 years of experience in Coordinator of Benefits (COB) or adjustments/refunds processing required
- Self-funded processing experience preferred
- Strong analytical ability
- Excellent oral and written communication skills
- Working knowledge of relevant PC software
- Full understanding of claims procedures, primacy rules, and claims processing guidelines
- Strong background in claims coding, processing, edits, and adjusting payments
- Ability to prioritize multiple streams of work effectively
Benefits
Comp & perks- Health insurance
- Retirement plans
- Paid time off
- Professional development opportunities