Claims Specialist II

Blue Cross and Blue Shield of Louisiana

Claims Specialist II processing medical claims, COB records, adjustments, and overpayment recoveries for Louisiana Blue. Investigating cases and coordinating with providers, members, insurers, and internal departments.

Posted 8/4/2026full-timeRemote • Louisiana • 🇺🇸 United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical claims processing, including Coordination of Benefits (COB) and recovery procedures. Strong analytical and communication skills are essential for resolving claims issues and maintaining accurate records.

Highest-signal resume keywords

Medical Claims ProcessingCoordination of Benefits (COB)Analytical AbilityOral and Written Communication SkillsPC Software Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims EditsBenefit RecalculationsClaims ResearchOverpayment RecoveryDenial CodesProcessing CodesQuality AuditsMedical Record RequestsProblem AnalysisSpecial Projects Execution

Soft Skills

Strong Human Relations SkillsAbility to Prioritize Multiple Streams of Work

Industry Keywords

Claims ProcessingRecovery ProceduresLouisiana ResidencyBackground ChecksPre-Employment Drug Screening

About the role

Key responsibilities & impact

Process claims edits accurately and determine primacy for Coordination of Benefits (COB)
Adjust previously paid claims and initiate recovery procedures for overpaid claims
Analyze, investigate, and resolve problem cases
Execute recovery processes and complete special projects
Review, research, and update claims, including benefit recalculations, claims edits, and refund requests
Maintain understanding of systems, applications, denial codes, edits, and processing codes to process coordinated and non-coordinated claims correctly
Request medical records when required
Communicate with internal and external contacts to establish accurate claim records
Review quality audits and correct or route them within 48 hours
Research and determine the correct order of benefits and correct COB records
Notify appropriate departments when Medicare determines primacy incorrectly
Review processed claims for payment consistency and maximize overpayment recovery
Recover funds from providers, subscribers, or beneficiaries when overpayments occur
Assist with training, implementations, and documentation
Perform other assigned duties and special projects

Requirements

What you’ll need

High School Diploma or equivalent required
2 years in medical claims processing required
Coordination of Benefits (COB) processing experience preferred
Strong analytical ability, including logical, systemic, and investigative thinking
Strong oral and written communication skills
Strong human relations skills
Working knowledge of relevant PC software
Ability to prioritize multiple streams of work effectively
Ability to comprehend, document, calculate, visualize, and analyze
No licenses or certifications required
Must complete pre-employment drug screening
Subject to background and pre-employment checks after an offer
Louisiana residency or relocation is preferred

Benefits

Comp & perks

Resources to live well and be healthy
Continued learning and skill development
Professional growth opportunities
Smoke- and tobacco-free workplace
Background and pre-employment drug screening after an offer
Reasonable accommodations for individuals with disabilities