Claims Processor

Now Hiring for a June 30th start date!

You must live in the state of Minnesota to be eligible for this role.

We're looking to hire around 20 Claims Processors to support various lines of business, including ITS Host, FEP, ITS Home, COB, ORC, Medicare, State of MN, Local Adjustments, Pharmacy, VADD, and MSP. This is a fully remote position!

We provide paid training to set you up for success in this role! Training begins 06/30/2025. Schedule during training: Monday - Friday from 8:00 AM - 4:30 PM, Schedule after training is flexible and could vary between 6:00 AM - 5:00 PM CST, Monday-Friday. (Specific schedule will be determined after training).

This position will be full-time remote, work from home position. You are required to have an Internet Service Provider (ISP) that has a high-speed internet land-based connection. To ensure stable performance, the connection must be hard-wired from the router to the company provided equipment.

The rate of pay in this role will be $22.50 - $23.50/hour

The Impact You Will Have

As a Claims Processor, you will screen, review, evaluate online entry, error correction and / or quality control review and final adjudication of paper/electronic claims. You will determine whether to return, deny or pay claims following organizational policies and procedures. Reviews processed claims and inquiries to determine corrective action which can include adjusting claims. Take the corrective action steps using enrollment, benefit and historical claim processing information. These responsibilities may include adjusting claims for COB, Auto, Workers' Comp and Subrogation. It may also include researching, reviewing, and resolving money sent to BCBSMN from providers, subscribers, other Blue Plans, and/or other sources.

Your Responsibilities

• Initiates or receives telephone and/or written responses to requests for information.
• Verifies and/or obtains and documents information to correctly process claims and update records.
• Determines primacy, student dependent status or appropriate action from information that is gathered.
• Updates claims/membership system with appropriate information.
• Research history for pended and/or rejected claims and prepares claims to be adjusted, if appropriate. Ensures timely and accurate payment or denial of specialized paper claims, including account specific, carry over deductibles, contract specific, provider specific, etc.
• Serves as a mentor for less experienced processors, and a resource for other internal departments.
• Determine if claim information is complete and correct. Enter/verify claims data.
• Resolve claim edits, review history records and determine benefit eligibility for service.
• Review payment levels to arrive at final payment determination.
• Meets all production and quality standards. Attends all required training classes. Elevates issues to next level of supervision, as appropriate.

Required Skills and Experiences

• 2+ years of related experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• Proficient at using Microsoft systems, especially Excel.
• Strong attention to detail and accuracy.
• Self-driven with the ability to work independently and seek solutions to problems by taking personal accountability for their performance and actions.
• Demonstrated flexibility to adapt to changes in procedures and job assignments.
• Computer literacy and typing skills (Ability to learn new process, technology, etc.).
• Strong communication and listening skills.
• Ability to adapt to ever changing health care requirements and processes.

Preferred Skills and Experience

• Experience in claims processing or related experience such as medical billing and coding, healthcare administration, customer service in healthcare or insurance industries, financial services, legal assistance, and/or data entry.
• Proficiency in claims processing software such as Facets, OPIS, OCWA, etc
• Ability to use mathematics to adjudicate claims.
• Ability to take direction and to navigate through multiple systems simultaneously
• Knowledge of healthcare regulations and compliance
• Associate or bachelor's degree

Compensation and Benefits:

Pay Range: $21.00 - $23.86 - $28.63 Hourly

Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.

We offer a comprehensive benefits package which may include:

• Medical, dental, and vision insurance
• Life insurance
• 401k
• Paid Time Off (PTO)
• Volunteer Paid Time Off (VPTO)
• And more

To discover more about what we have to offer, please review our benefits page.