Claims Adjudicator

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Grand Rapids, MI

Blue Cross Blue Shield of Michigan

When you think of <a href="" target="_blank" rel="noopener noreferrer">Blue Cross Blue Shield of Michigan</a> for health insurance, you can know you&rsquo;re getting much more. We're a company founded on a tradition of affordable, quality health care for everyone, improving the present and investing in the future.&nbsp;<br /><br />We offer:<br />Plans for employers and individuals that meet today&rsquo;s needs, budgets and lifestyle<br />The largest network of doctors and hospitals in the state<br />Lower health care costs Higher quality health care<br />Award-winning diversity practices<br />Grants and programs that promote better health throughout Michigan<br /><strong><br />Mission:&nbsp;</strong>We commit to being our members&rsquo; trusted partner by providing affordable, innovative products that improve their care and health.<br /><br /><a href="" target="_blank" rel="noopener noreferrer"><strong>Click here</strong></a> to learn more about our commitment to our Social Mission, view company updates and reviews, and view our awards &amp; accolades.<br /><br />For Application Timeline &amp; Selection Process:&nbsp;<a href="" target="_blank" rel="noopener noreferrer">Click Here</a>. Learn more about your options as an external candidate. <a href="" target="_blank" title="BCBSM" rel="noopener noreferrer">Click here</a> to view open positions.

keywords: job description,claims,projects,education,experience,skills


Competitive Total Compensation Package

Overview: <br /><br /> <div> <p><strong>Non-Exempt/Bargaining Unit Posting - nonexempt</strong></p> <p><strong>Local/Seniority Unit- 2145</strong></p> <p><strong>Date Posted&nbsp;- 8/24/21</strong></p> <p><strong>Deadline Date - 8/31/21</strong></p> <p><strong>Job Title &ndash; Claims Adjudicator</strong></p> <p><strong>Department -&nbsp;</strong>127220 BCN-Claims Adjudication</p> <p><strong>Salary Grade -&nbsp;UE - Please reference Appendix A of the BCBSM/BCN MLA</strong></p> <p><strong>Job Code -&nbsp;</strong>1M10U</p> <p><strong>Number of Openings - multiple</strong></p> <p><strong>Status &ndash; regular FT</strong></p> <p><strong>Site- Grand Rapids<br /><br /></strong></p> </div> <div>Responsible for the adjudication of medical claims at all pend levels in an accurate and timely manner as required by corporate and departmental standards on accuracy and production.</div>
Responsibilities: <br /> <ul> <li>Responsible for the resolution of pended claims in an accurate and timely manner according to departmental processes, procedures, and guidelines and in compliance with departmental and corporate standards for accuracy, quality, and production.</li> <li>Responsible for resolution of system Batch Errors.</li> <li>Responsible for initiating inquiries to other parties as needed to address pended claims issues or resolving inquiries associated with claims adjudication.</li> <li>Perform other reasonably related duties, including special projects as assigned by immediate supervisor and other management staff as required.</li> </ul>
Requirements: <br /> <ul> <li>High School Diploma required. Associate's or Bachelor's degree in Health Care or related field preferred. Ability to meet one of the following requirements: <ul> <li>One year of claims processing/claims resolution experience on an automated claims processing system to have included strong knowledge and use of CPT/ICD codes and standard health claim billing forms.&nbsp;<strong>OR</strong></li> <li>Two years of claims-related experience or provider billing/coding experience, which included significant use and application of CPT/ICD codes and standard health industry claim billing forms. Must be able to demonstrate knowledge of medical terminology, coding, billing, and claims processing obtained through work experience and/or completion of relevant claims or billing coursework.&nbsp;<strong>OR</strong></li> <li>Associate's or Bachelor's degree in healthcare claims or billing which included significant coursework and demonstrated knowledge of CPT and ICD coding, standard billing forms and medical terminology may be accepted in lieu of actual claims processing experience.</li> </ul> </li> <li>Ability to create or modify existing Microsoft Office Suite software (e.g. Word, PowerPoint, Excel, and Access) documents and reports required.</li> <li>Good oral, written communication, and reading comprehension skills with the ability to interpret complex procedures.</li> <li>Successful experience working in a team environment.</li> <li>Analytical problem-solving skills.</li> </ul>