Claims Research Specialist Senior Job
Blue Cross Blue Shield of Minnesota
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Post Date: Nov 15, 2017
Job Type: Full time
Start Date: - n/a -
Salary: - n/a -
Location: US - Minnesota - Eagan
Job Reference: 18321-en_US
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Description
About Blue Cross

For more than 80 years, Blue Cross and Blue Shield of Minnesota has worked to improve the health of all Minnesotans. As a nonprofit organization, we have a long history of making a healthy difference in people’s lives and of giving back to the communities we serve. In particular, our industry-leading commitment to veterans, service members and their families helped us to be named the first and only Beyond the Yellow Ribbon health plan company in Minnesota.

We make it easy for you to support veterans groups and other community organizations by providing 20 hours of volunteer paid time off each year — in addition to regular paid time off. The dedication of Blue Cross volunteers has earned us recognition for running one of the most successful corporate food drives in the state; donating nearly 1,500 volunteer hours at Habitat for Humanity worksites; and growing more than 750 pounds of fresh produce at our onsite Community Giving Gardens. Find your place at a company that cares about veterans, our employees, our members and our communities.
Description Summary This position is responsible for contacting members and providers in order to collect and verify information. This position is also responsible for the adjudication of complex paper claims and working of reports that identify more research if necessary. Accountabilities
Initiates or receives telephone and/or written responses to requests for information.
Verifies and/or obtains and documents information in order to correctly process claims and update records.
Determines primacy, student dependent status or appropriate action from information that is gathered. Updates claims/membership system with appropriate information.
Researches history for pended and/or rejected claims and prepares claims to be adjusted, if appropriate.
Requests records, if necessary.
Monitors and works reports.
Ensures timely and accurate payment or denial of specialized paper claims, including account specific, carry over deductibles, contract specific, provider specific, etc.
Serves as a mentor for less experienced Claims Research Specialists, and a resource for other internal departments.
Displays above expected performance for a minimum of three consecutive months as a Claims Research Specialist.

Requirements

    Completion of Claims Examiner training or a minimum of 12 months experience as a Claims Research Specialist.
    Research and analytical skills required. ·

Preferred Requirements FLSA Status Non-Exempt Blue Cross Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, or any other legally protected characteristic.

 

Make a difference

Thank you for your interest in Blue Cross. Be part of a company that lets you be you — and make a healthy difference in people’s lives every day

Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, or any other legally protected characteristic.

Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association



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