Claims Examiner

Join Blue: Make a DifferenceWhy Join Us? Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans. Family Comes First: Total rewards package that promotes the idea of family first for all employees. Paid vacation and sick leave with paid maternity and paternity available immediately upon hire Professional Growth Opportunities: Advance your career with ongoing training and development programs. Dynamic Work Environment: Collaborate with a team of passionate and driven individuals in a work environment that promotes flexibility. Trust and Stability: Work for one of the most trusted companies in Kansas with over 80 years of commitment, compassion and community. Inclusive Work Environment: We pride ourselves on fostering a workplace where everyone is valued and respected. Benefits & Perks Base compensation is only one component of your competitive Total Rewards packageIncentive pay program (EPIP) Health/Vision/Dental insurance 6 weeks paid parental leave for new mothers and fathers Fertility/Adoption assistance 2 weeks paid caregiver leave 401(k) plan matching up to 5% Tuition reimbursement Health & fitness benefits, discounts and resourcesJob Summary A health claims examiner is responsible for reviewing, evaluating, and processing health, drug, dental and/or ancillary product claims submitted by members or providers for insurance reimbursement. The job involves ensuring that claims are processed accurately and timely, in accordance with policy terms, industry regulations, and company guidelines. This pool will start training on May 26, 2026 This position is eligible to work remotely or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment. What You'll Do Claims review and verificationAccurately review, analyze, and verify healthcare claims submitted by policyholders or medical providers. Ensure all necessary documentation, coding (International Classification of Diseases, Tenth Revision (ICD-10), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS)), and data are included and correct. Check for eligibility, coverage, and applicable benefits as per policy terms.Claims ProcessingEnter and process claims information into the system with precision and attention to detail. Apply appropriate insurance guidelines, including deductibles, co-pays, co-insurance, and maximum coverage limits. Approve or deny claims based on policy coverage, ensuring compliance with regulatory and company standards. Perform adjustments to processed claims as needed for corrective action.CommunicationCorrespond with healthcare providers, patients, and internal departments to clarify or resolve discrepancies.Problem ResolutionInvestigate and resolve complex or escalated claim issues, such as coding errors, benefit misunderstandings, or billing discrepancies.Compliance and DocumentationEnsure compliance with state and federal healthcare regulations. Maintain detailed and accurate records of all claims processed, including documentation for audits or reviews.Efficiency and QualityMeet individual and team performance targets related to claims processing speed, accuracy, and quality. Participate in ongoing training to stay updated on changes in health insurance policies and claims processing technologies. Monitor and work daily reports to ensure timely claim control.What You Need Knowledge/Skills/Abilities Strong attention to detail and organizational skills. Knowledge of medical claim processing, medical terminology, insurance policies, and coding standards (ICD, CPT). Excellent communication skills, both written and verbal. Ability to work efficiently under pressure and meet deadlines. Critical thinking and problem solving skills Office and/or computer system experience preferred Education and Experience: High school diploma or equivalent required Previous experience in healthcare claims processing, medical billing, medical terminology, or health insurance is preferred. Physical Requirements Office setting, with remote or hybrid work opportunities depending on the department. May involve long periods of time working on a computer. Compensation $20.96-$26.20 Non- Exempt Grade 11Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts. Our Commitment to Connection and Belonging At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law. Blue Cross and Blue Shield of Kansas conducts pre-employment drug screening, criminal conviction check, employment verifications and education as part of a conditional offer of employment.