Claims Processor, Intermediate

About the position The Claims Processor role at Blue Shield of California involves processing complex and specialty claims in accordance with organizational policies and procedures. This position is crucial for ensuring timely and accurate claims adjudication, contributing to the overall operational, financial, and service goals of the organization. The Claims Processor will work independently and collaboratively, providing guidance to less experienced team members while maintaining high standards of customer service. Responsibilities • Review and adjudicate complex/specialty paper/electronic claims. , • Determine whether to return, deny, or pay claims following organizational policies and procedures. , • Provide guidance or expertise to less experienced claims processors. , • Perform back-end processing and resolve complex edits using available documents/job aids with minimum direction. , • Handle front-end processing and difficult adjustments. , • Coordinate with other departments for resolution on special processing assignments. , • Understand the fundamentals of end-to-end claims processing. , • Meet established performance metrics and deadlines with excellent quality. , • Manage time effectively and multi-task while performing detailed research. Requirements • High school diploma or GED required. , • At least 3 years of experience in claims processing or related field. , • Basic experience in Microsoft Office is required. , • Experience with Microsoft Excel is preferred. , • Math skills are preferred. Nice-to-haves Benefits • Work from home options , • Flexible work environment , • Health insurance coverage , • Paid time off , • Retirement savings plan options Apply Job!