Claims Processor (Medicaid, hybrid) - Blue Cross Blue Shield of Arizona

Inspiring Health in Arizona Starts with You

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Our benefits support work-life balance and the flexibility you need to be your best.

They include:

• Eleven (11) paid holidays, including a floating holiday you can use any time you wish

• Accrued paid time off (up to 18 days per calendar year)

• Comprehensive medical, dental, and vision coverage

• 401(k) up to 5% dollar-per-dollar match, 2% non-elective employer contribution

• Eight (8) paid volunteer hours to support our mission of inspiring health

• Tuition reimbursement for you; scholarship opportunities for your children

• Employee discounts, gym reimbursement, and wellness programs

• Treadmill desks, full-service fitness center, onsite cafeterias

• Ongoing training for employees who wish to grow in their careers, acquire skills, and become managers

To thrive in this job, you must be able to:

• Maintain confidentiality and privacy

• Compose and dictate a variety of business correspondence
• Interpret and translate policies, procedures, programs, and guidelines
• Perform investigative and analytical research
• Maintain production and quality standards to help ensure claims are processed correctly the first time
• Navigate, gather, input, and maintain data records in multiple system applications
• Follow and accept instruction and direction
• Establish and maintain working relationships in a collaborative team environment

Responsibilities

• Adjudicate claims according to regulatory, contractual and health plan requirements

• Pre-screen accuracy of EDI submissions through review of data elements in claims system

• Verify a claim is not a duplicate of a previously submitted claim

• Keep updated with processing manual and other educational/training materials

• Know and adjudicate claims according to COB provisions

• Identify and refer TPL issues to appropriate department

• Identify and refer medical review claims to appropriate department

• Identify and refer potential FWA claims to appropriate department

• Identify opportunities for provider education

• Identify opportunities for process improvement, including auto adjudication

Qualifications

• High school diploma or GED (required)

• Associate degree in a general field of study (preferred)

• At least one year of prior work experience

• Experience with claims processing, including UB, 1500, and dental

• BPT/HCPC and ICD10 coding skills

• Knowledge of Medicaid and Medicare

• Intermediate PC proficiency, including the ability to type at least 30 words per minute with 95% accuracy

Why Join Blue Cross Blue Shield of Arizona?

At BCBSAZ, your pursuit of balance, happiness, and fulfillment is supported through our Workability model. Workability is our workforce strategy and defines where and how we do our jobs.

Our award-winning healthy campus in Phoenix is always available to you. Access telehealth services at our BlueCare Anywhere kiosk, fuel up with healthy meals and snacks at our Work Perks Café, and make the most of our onsite fitness center by taking advantage of personal trainers, a nutritionist, Health Support programs, and daily group fitness classes, including spin, yoga, and Zumba.