Senior Claims Processor – Anthem BlueCard PPO
Job Title: Senior Claims Processor – Anthem BlueCard PPO
Location: Remote
Employment Type: Full-Time
About the Role
We are seeking a highly skilled Senior Claims Processor with specialized expertise in Anthem BlueCard PPO claims. The ideal candidate will have at least 5+ years of hands-on experience processing BlueCard PPO claims with accuracy and compliance. This role requires advanced knowledge of CMS and payer-specific guidelines, strong analytical skills, and the ability to resolve complex claim issues while mentoring junior processors.
Key Responsibilities
• Review, analyze, and process Anthem BlueCard PPO claims, including institutional, professional, outpatient, and inpatient claims.
• Apply CMS, Medicare, Medicaid, and commercial payer guidelines to ensure compliance.
• Accurately adjudicate claims using ICD-10, CPT, HCPCS, and coding modifiers.
• Resolve denials, escalations, and exceptions with sound judgment.
• Utilize claims processing systems (Facets, Epic, QNXT, or similar) and EHR/billing platforms.
• Collaborate with providers, facilities, and internal teams to address claim issues.
• Stay current on payer policy changes and apply them effectively.
• Mentor and support junior processors, providing training and sharing best practices.
• Maintain HIPAA compliance while processing a high volume of claims with accuracy.
Qualifications
• 5+ years of Anthem BlueCard PPO claims processing experience (required).
• Strong understanding of CMS guidelines and payer-specific requirements.
• Proficient with ICD-10, CPT, HCPCS coding, and claims adjudication.
• Hands-on experience with claims platforms (Facets, Epic, QNXT, or similar).
• Skilled in Excel, Outlook, Teams, and other data review tools.
• Strong communication skills for provider and internal team interactions.
• Proven problem-solving and critical-thinking ability in high-volume claim environments.
• Experience mentoring and training team members.
• Attention to detail with a commitment to compliance and accuracy.
Why Join Us?
• 100% remote work environment
• Opportunity to specialize in complex Anthem BlueCard PPO claims
• Collaborative team culture with leadership opportunities
• Professional growth and development support
Job Type: Full-time
Pay: $25.00 - $35.00 per hour
Expected hours: 40 per week
Benefits:
• Dental insurance
• Life insurance
• Paid time off
• Vision insurance
• Work from home
Work Location: Remote
Apply Now
Apply Now
Location: Remote
Employment Type: Full-Time
About the Role
We are seeking a highly skilled Senior Claims Processor with specialized expertise in Anthem BlueCard PPO claims. The ideal candidate will have at least 5+ years of hands-on experience processing BlueCard PPO claims with accuracy and compliance. This role requires advanced knowledge of CMS and payer-specific guidelines, strong analytical skills, and the ability to resolve complex claim issues while mentoring junior processors.
Key Responsibilities
• Review, analyze, and process Anthem BlueCard PPO claims, including institutional, professional, outpatient, and inpatient claims.
• Apply CMS, Medicare, Medicaid, and commercial payer guidelines to ensure compliance.
• Accurately adjudicate claims using ICD-10, CPT, HCPCS, and coding modifiers.
• Resolve denials, escalations, and exceptions with sound judgment.
• Utilize claims processing systems (Facets, Epic, QNXT, or similar) and EHR/billing platforms.
• Collaborate with providers, facilities, and internal teams to address claim issues.
• Stay current on payer policy changes and apply them effectively.
• Mentor and support junior processors, providing training and sharing best practices.
• Maintain HIPAA compliance while processing a high volume of claims with accuracy.
Qualifications
• 5+ years of Anthem BlueCard PPO claims processing experience (required).
• Strong understanding of CMS guidelines and payer-specific requirements.
• Proficient with ICD-10, CPT, HCPCS coding, and claims adjudication.
• Hands-on experience with claims platforms (Facets, Epic, QNXT, or similar).
• Skilled in Excel, Outlook, Teams, and other data review tools.
• Strong communication skills for provider and internal team interactions.
• Proven problem-solving and critical-thinking ability in high-volume claim environments.
• Experience mentoring and training team members.
• Attention to detail with a commitment to compliance and accuracy.
Why Join Us?
• 100% remote work environment
• Opportunity to specialize in complex Anthem BlueCard PPO claims
• Collaborative team culture with leadership opportunities
• Professional growth and development support
Job Type: Full-time
Pay: $25.00 - $35.00 per hour
Expected hours: 40 per week
Benefits:
• Dental insurance
• Life insurance
• Paid time off
• Vision insurance
• Work from home
Work Location: Remote
Apply Now
Apply Now