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: RemoteApply Now

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