Claims Representative
Full Job Posting
What You’ll Do
Process, adjust or update various routine claims payments and payment errors for singular business segment and/or claims-provider type
Respond promptly and accurately to inquiries from Core Service, subscribers, providers, physicians and other insurance carriers regarding claims payments
Meet or exceed established quality and performance standards
Determine suspended claim resolution methods by reviewing benefit eligibility, claims history and other information
Identify system problems, including documentation of the issue, recommendation of potential solutions, referral to appropriate technical staff and follow-up to ensure resolution
Assist management by identifying and analyzing opportunities for improvements in BCBSNC processes, policies and services
May coordinate with other insurance carriers and Medicare to determine BCBSNC payment liability
Review claims for possible “fraud and abuse” and send to Special Investigations Unit for additional investigation
What You Bring
High school diploma or GED
0-2 years of experience in related field.
Bonus Points (Preferred qualifications)
Data entry experience is a plus.
What You’ll Get
The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community
Work-life balance, flexibility, and the autonomy to do great work
Medical, dental, and vision coverage along with numerous health and wellness programs
Parental leave and support plus adoption and surrogacy assistance
Career development programs and tuition reimbursement for continued education
401k match including an annual company contribution
Learn more
Where You’ll Work
Our Hybrid Flex approach is built on presence with a purpose – giving you flexibility to work remotely with intentional in-person connection – that supports a workplace that’s flexible, connected, and future focused.
In a Hybrid-Flex role, you’ll work in the office at least two days a week for collaboration and connection. In a Remote Flex role, you’ll work virtually, with a few in-office visits each year for meaningful moments that matter.
Whether your role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any states listed on this job posting. Onsite expectations will be discussed during the interview process.
Salary Range
- At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.
- *Based on annual corporate goal achievement and individual performance.
Skills
- _____________________________________________________________________ JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC . If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: [email protected] .
About Blue Cross and Blue Shield of North Carolina
Not-for-profit North Carolina health insurer providing health plans to members, employers, and government programs.
Visit company websiteJobs and hiring trendsApply for this job in 1 click
Skip the repetitive application forms
Install the Base Career Chrome Extension and autofill job applications across major job boards with your profile.
Trusted by over 500,000 job seekers on Base Career
More from this employer
More jobs at Blue Cross and Blue Shield of North Carolina
BI Analyst
Durham, USA
Blue Cross NC is seeking a BI Analyst to deliver reporting and analytics for Federal Employee Program Clinical Operations. The role develops dashboards, analyzes healthcare and operational data, evaluates program outcome
Principal BI Analyst
, USA
Blue Cross NC is seeking a Principal BI Analyst to lead enterprise data visualization architecture, governance, and analytic report development. Candidates need Facets and healthcare claims processing knowledge, CMS guid
Sr. Strategic Advisor, Pharmacy
Durham, USA
Blue Cross NC seeks a senior pharmacy strategist to develop cost-saving, revenue-generating products and lead initiatives that advance enterprise value. Candidates need a bachelor’s degree and 6+ years, or a master’s deg
Director Operations Support
, USA
Blue Cross NC is seeking a Director of Operations Support to lead teams and improve operational systems, processes, and service quality. The role oversees budgets, staff, applications, projects, audits, training, and con
BI Analyst
Durham, USA
Principal BI Analyst
, USA
Sr. Strategic Advisor, Pharmacy
Durham, USA
Director Operations Support
, USA
Team Leader, Appeals
, USA
Case Manager
, USA
Principal Program Manager - Vendor Integration
, USA