Pricer VI

<p>With more than 7,000 employees, we are the largest health insurance company in Michigan. We offer an exciting work environment with a diverse group of employees. Our goal is to make health insurance easier for our members. We want to transform the industry and become a resource that people can trust.</p>

Detroit, 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.<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 />Learn more about your options as an external candidate. <a href="" target="_blank" rel="noopener noreferrer">Click here</a> to view open positions.&nbsp;

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Competitive Total Compensation Package

Overview: Claims adjudication position which requires reviewing and processing medical and/or dental claims and adjustments for various corporate business units.
Responsibilities: <ul> <li>Enter claims into the claims processing system.</li> <li>Review and process less complex medical claims, which may involve COB claims, supplemental claims and/or adjustments/write-offs, for approval/denial, including eligibility and various claim edits for diverse benefit categories, according to corporate and departmental policies, procedures and other guidelines while adhering to quality and productivity standards.</li> <li>Interpret benefits and determines liability applying appropriate rules.</li> <li>Utilize various online processing systems to adjudicate claims.</li> <li>Notify leadership of system problems or possible fraud situations.</li> <li>Contact internal and external resources via phone or written communication for additional information required to process payments.</li> <li>Maintain history and detail history display updates.</li> <li>Perform other related duties as assigned.</li> </ul>
Requirements: <ul> <li>High School Diploma or GED required. Associates or Bachelors degree in Health Care or related field preferred.</li> <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 (UB-04, CMS1500).</li> </ul> <p>-OR-</p> <ul> <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 (UB-04, CMS 1500). 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.</li> <li>Associates or bachelors degree in health care 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> <li>Verbal and written communication skills required to obtain information and prepare general correspondence.</li> <li>Math skills required to calculate payment amounts.</li> <li>Analytical skills necessary for benefit interpretation and application.</li> <li>Knowledge of general office procedures and ability to operate basic PC software and keyboarding skills.</li> <li>Knowledge of medical claims, benefits/contracts and claim processing policies and procedures, as identified by line of business.</li> <li>Ability to access and interpret benefit files and benefit displays via computer terminal.</li> <li>Other related skills and/or abilities may be required to perform this job.</li> </ul> <div><em>All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.</em></div>