LMI Claims Specialist assessing and managing complex LMI claims for QBE’s insurance team. Delivering high - quality outcomes while providing technical expertise and compliance oversight.
About the role
- Claims Processor II reviewing complex specialty claims at BlueCross BlueShield. Assisting in training while ensuring claims are processed according to policies and procedures.
Responsibilities
- Reviews and adjudicates complex or specialty claims.
- Determines whether to return, deny or pay claims following organizational policies and procedures.
- Assists in training or mentoring new staff members.
- Examines and processes complex or specialty claims according to business/contract regulations, internal standards and examining guidelines.
- Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes.
- Verifies that claims have been keyed correctly.
- Ensures that claims are processing according to established quality and production standards.
- Corrects processing errors by reprocessing, adjusting, and/or recouping claims.
- Researches and resolves claims edits and deferrals.
- Performs research on claim problems by utilizing policies, procedures, reference materials, forms and coordinates with various internal support areas.
- Responds to routine correspondence and completes spreadsheet if applicable.
Requirements
- High School Diploma or equivalent
- 2 years of experience processing, researching and adjudicating claims.
- Strong organizational, analytical and judgment skills.
- Strong oral and written communication skills.
- Proficient in spelling, punctuation and grammar.
- Proficient in basic business math.
- Ability to handle confidential or sensitive information with discretion.
- Microsoft Office proficiency.
- 2 years of claims processing experience preferred.
- Strong time management skills preferred.
- Knowledge of mathematical and statistical concepts preferred.
- Proficient in word processing and spreadsheet applications preferred.
- Proficient database software skills preferred.
Benefits
- Subsidized health plans
- Dental and vision coverage
- 401k retirement savings plan with company match
- Life Insurance
- Paid Time Off (PTO)
- On-site cafeterias and fitness centers in major locations
- Education Assistance
- Service Recognition
- National discounts to movies, theaters, zoos, theme parks and more
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