ITS Special Claims Processor Blue Cross Blue Shield of Louisiana 197 reviews - Los Angeles, CA We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross. You should know that: * Jobs are updated and posted daily. * You must submit your resume online. * Apply for each position for which you are qualified and interested in. * You will only be considered for positions for which you apply. * Resumes are only accepted for posted positions. * Positions are full-time unless otherwise stated. * Due to the high volume of applicants, only those most qualified will be contacted. * We are unable to accept phone calls. Grade 5 POSITION PURPOSE : Researches and verifies complex claims information to ensure the accurate and timely processing of claims. Enters all information needed to process a claim. Identifies inconsistencies and computes adjustments. Accountable for complying with all laws and regulations associated with duties and responsibilities. NATURE AND SCOPE : Position Location : This position reports to Supervisor, ITS Coding. Activities of Direct Reports : This position has no direct reports. Necessary Contacts : In order to effectively fulfill this position the incumbent must be in contact with: Benefits Administration, Network Administration and other employees as necessary. Subscribers and providers as needed. QUALIFICATIONS : High school degree or equivalent. One year of related clerical or data entry required. Claims processing experience is preferred. A medical office or medical coding diploma can be used in lieu of the one year experience. Must be able to type and perform 10 key data entry. Working knowledge of relevant PC software including Windows, Microsoft Word, Excel, Outlook preferred along with FACETS, etc. Must possess the ability to learn new systems. ACCOUNTABILITIES & ESSENTIAL FUNCTIONS : Enters coded information, checks claim for completeness and accuracy of information prior to final entry, identifies and resolves inconsistencies, and appropriately returns claims requesting missing information in accordance with established quantity, quality, and timeliness guidelines in order to ensure contract benefits are applied correctly, ultimately providing a high degree of customer satisfaction and BlueCard Performance. Consistently researches procedural questions using the edit manuals, identifies incomplete adjudication instructions found within the manual, offers suggestions for correct adjudication procedures, identifies training issues, and appropriately checks with manager/lead when necessary, to provide excellent quality in claim adjudication. Maintains and records information necessary for the Work Management Module, number of edits processed and hours worked, on a daily basis, in order to retain historical data needed to continually refine and define the special claims processor position as needed to ensure high customer satisfaction. Accountable for complying with all laws and regulations associated with duties and responsibilities. Job Duties are performed in a normal and clean office environment with normal noise levels. Work is predominately done while sitting or standing. The ability to comprehend, document, and analyze is required. An Equal Opportunity Employer All BCBSLA EMPLOYEES please apply through Workday Careers. 3 hours ago - save job - original job Apply On Company Site Other jobs you may like Medical Claims Processor Network Medical Management Alhambra, CA 30+ days ago Easily apply * Its Special Claim Processor jobs in Los Angeles, CA * Its Special Claim Processor salaries in Los Angeles, CA Blue Cross Blue Shield of Louisiana 197 reviews Let employers find you Thousands of employers search for candidates on Indeed Upload Your Resume