oracle
Claims Processor, Advanced
Blue Shield of California
Redding, USA
Full-time
Mid · 5+ years experience
Onsite
Discovered 6 days ago
Full Job Posting
Qualifications
- Your Knowledge and Experience
- High School Diploma or GED or 1 year of additional relevant experience in lieu of a diploma required
- 5 years of previous experience required
- Requires broad knowledge of operational systems and practices within Claims Processing
- Proficiency in front and back-end processing with the ability to not only identify errors but to analyze and resolve them
- Demonstrated ability in processing multiple claim types or specialties
- Deep understanding of end-to-end claims processing fundamentals
- Intermediate-Advanced skills creating documents/files using Excel, Outlook, Power Point, and Word
- Ability to work independently as well as in a team environment
- Strong ability to manage time effectively and detailed research skills
- Hybrid
- This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.
- Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.
Responsibilities
- Your Work
- In this role, you will:
- Research accumulations and update accordingly
- Independently process complex and high-risk claims across multiple products or specialties
- Pull, format and send reporting to necessary teams
- Reviews applications and recommends system edits/changes as needed
- Be given special processing assignments; coordinate with other departments for resolution if needed
- Consistently exceed performance metrics and quality standards
- Manage time effectively, multi-task, demonstrate detailed research skills, meet deadlines with excellent quality
- Serve as a subject matter resource for selected claim types, providing guidance to peers
- Identify, analyze, and resolve system and processing errors with minimal escalation
- Assist with training, documentation review, and workflow support; act as backup to lead roles
- Other duties as assigned
About Blue Shield of California
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