Blue Cross And Blue Shield Of Kansas
Insurance
ClaimsSpecialist
“Claims Specialist at Blue Cross And Blue Shield Of Kansas. Skills: Claim administration, Policy provisions, Regulatory requirements. Review, investigate, and adjudicate all claims. Verify eligibility, coverage, and contract provisions”
Industry & Context.
Analyze detailed contract provisions; Make decisions based on facts
Ability to lift and carry up to 25 pounds, Ability to stand or sit for extended periods, Ability to look at a computer screen for prolonged periods, Occasional walking, bending, or reaching, Ability to bend, kneel, stoop, or reach, Ability to perform repetitive tasks, Willing to relocate
What They're Looking For.
Must Have
High school diploma or equivalent required, Licensed Practical Nurse license required, Certified Nurses Aid license required, Certified Medical Aid license required, 2 years experience in professional/clinical/medical office with billing, Reside in Kansas or Missouri
Nice to Have
Extensive knowledge of ERISA/FICA regulations, 1 years’ experience with Kansas Department of Insurance regulations for life/disability products
What You'll Do.
and adjudicate all claims
and contract provisions
Obtain additional information from external partners
Ensure claim handling complies with regulatory requirements
Process claims within statutory timeframes
Interpret and apply policy provisions
Determine claim payability
Confirm reinsurer liability
Conduct in-depth investigations on complex claims
Coordinate with investigators or rehabilitation specialists
Prepare documentation for legal proceedings
Manage disability claims lifecycle
Review and process continuance requests
Evaluate treatment plans
Assess rehabilitation or return-to-work options
Communicate claim decisions and policy provisions
Respond to denials and inquiries
Manage overpayment recoveries and collections
Establish and monitor repayment arrangements
Maintain accuracy of claim accounts and systems
Make necessary adjustments
Approve claims for payment
Research and respond to State Insurance Department complaints
Implement corrective actions
Maintain required complaint logs
Support contract updates
Support product development initiatives
Collaborate across departments
Participate in Ad Hoc teams
Identify operational or compliance improvement opportunities
Compile and report financial and operational data
Report Schedule F for Annual Statement
Report management data
Participate in system testing for claims payment platforms
Validate new releases
Validate defect fixes
How You'll Work.
Team & Collaboration
Collaborate across departments; Participate in Ad Hoc teams
Communication Scope
Written correspondence; Verbal communication
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