Claims Examiner

Blue Cross and Blue Shield of Kansas is a trusted healthcare organization committed to the well-being of Kansans. They are seeking a Claims Examiner responsible for reviewing, evaluating, and processing health claims to ensure accuracy and compliance with regulations and guidelines.ResponsibilitiesAccurately review, analyze, and verify healthcare claims submitted by policyholders or medical providersEnsure all necessary documentation, coding (International Classification of Diseases, Tenth Revision (ICD-10), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS)), and data are included and correctCheck for eligibility, coverage, and applicable benefits as per policy termsEnter and process claims information into the system with precision and attention to detailApply appropriate insurance guidelines, including deductibles, co-pays, co-insurance, and maximum coverage limitsApprove or deny claims based on policy coverage, ensuring compliance with regulatory and company standardsPerform adjustments to processed claims as needed for corrective actionCorrespond with healthcare providers, patients, and internal departments to clarify or resolve discrepanciesInvestigate and resolve complex or escalated claim issues, such as coding errors, benefit misunderstandings, or billing discrepanciesEnsure compliance with state and federal healthcare regulationsMaintain detailed and accurate records of all claims processed, including documentation for audits or reviewsMeet individual and team performance targets related to claims processing speed, accuracy, and qualityParticipate in ongoing training to stay updated on changes in health insurance policies and claims processing technologiesMonitor and work daily reports to ensure timely claim controlSkillsStrong attention to detail and organizational skillsKnowledge of medical claim processing, medical terminology, insurance policies, and coding standards (ICD, CPT)Excellent communication skills, both written and verbalAbility to work efficiently under pressure and meet deadlinesCritical thinking and problem solving skillsHigh school diploma or equivalent requiredOffice and/or computer system experience preferredPrevious experience in healthcare claims processing, medical billing, medical terminology, or health insurance is preferredBenefitsIncentive pay program (EPIP)Health/Vision/Dental insurance6 weeks paid parental leave for new mothers and fathersFertility/Adoption assistance2 weeks paid caregiver leave401(k) plan matching up to 5%Tuition reimbursementHealth & fitness benefits, discounts and resourcesCompany OverviewBlue Cross and Blue Shield of Kansas is a mutual insurance company provides Health Insurance, Dental Insurance, and Life Insurance. It was founded in 1942, and is headquartered in Kansas City, Missouri, USA, with a workforce of 1001-5000 employees. Its website is http://www.bcbsks.com.



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