EDUCATION
- High School diploma or equivalent.
EXPERIENCE
- Minimum two (2) years' college coursework (48 semester hours) or other equivalent certification with an emphasis in anatomy, medical terminology, math, biology, or a related field. OR minimum one (1) year of related office experience such as claims processing, health insurance, or medical office.
- Must pass company proficiency test: Claims Assessment
ESSENTIAL SKILLS & ABILITIES
- Oral & Written Communications
- Strong Interpersonal skills
- Sound Judgement
- Decision Making
- Detail-Oriented
- Teamwork
- Dependability
LOCATION
This role is 100% remote. Preference will be given to current employees and candidates who reside in Arkansas.
Skills• Clinical Judgment • Computer Work • Critical Thinking • Customer Service • Decision Making • Evaluating Information • Interpersonal Communication • Oral Communications • Organizing • Process Information • Reading Comprehension • Researching • Time ManagementResponsibilities• Claims Processing: Claims processing involves the actions required to pay or deny pended claims (those which did not auto-adjudicate), including: entering data into the system; reviewing and interpreting contract benefits; conducting edit and audit resolution; determining benefit eligibility; Identifying and researching processing issues through systems and manuals; routing claims to other areas; consulting internal staff and medical providers; generating correspondence; and completing forms to obtain necessary information • Knowledge/Continuous Learning: In order to perform the actions required of the Claim Specialist job, the incumbent must undergo initial training, on-the-job training, and continuing education. Demonstrating knowledge of and possessing the ability to access all relevant computer systems and screens in order to process claims accurately; staying current with continually changing processing procedures, benefits, and system modifications; being knowledgeable of and able to meet corporate and national (MTM) standards while maintaining acceptable performance levels based on established departmental standards for productivity and quality; and showing familiarity with corporate and professional manuals and guidebooks, including the company processing manual and ICD, CPT, and HCPS codebooks • Other duties: As assignedCertificationsHiring Range$19.77 - $25.68Security Requirements
This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual.
Segregation of DutiesSegregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual.
Employment TypeRegularADA Requirements
1.1 General Office Worker, Sedentary, Campus Travel - Someone who normally works in an office setting or remotely and routinely travels for work within walking distance of location of primary work assignment.
Skills Required
- High school diploma or equivalent
- Two years of college coursework, totaling 48 semester hours, emphasizing anatomy, medical terminology, math, biology, or a related field; alternatively, one year of related office experience in claims processing, health insurance, or a medical office
- Pass the company Claims Assessment proficiency test
- Oral and written communication skills
- Strong interpersonal skills
- Sound judgment and decision-making ability
- Attention to detail, teamwork, and dependability
Arkansas Blue Cross and Blue Shield Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Arkansas Blue Cross and Blue Shield and has not been reviewed or approved by Arkansas Blue Cross and Blue Shield.
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Healthcare Strength — Health coverage is described as broad and employer-subsidized, including an almost fully paid employee-only high-deductible plan and company-paid life and disability coverage. Wellness incentives and supportive programs are also cited as part of the health-focused offering.
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Affordable Benefits — Benefit costs for employee-only medical coverage are described as minimal on at least one plan, and company-paid protections reduce out-of-pocket spending. Feedback suggests these cost offsets materially increase the value of total rewards.
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Retirement Support — Retirement benefits include company 401(k) contributions and related programs that strengthen long-term financial security. These elements are positioned as notable parts of the overall package.
Arkansas Blue Cross and Blue Shield Insights
What We Do
Arkansas Blue Cross and Blue Shield provides reliable insurance plans to Arkansans while being a valuable community partner. We live here, work here and raise our families here – we are dedicated to Arkansas and to you. We work hard to improve the health, financial security and peace of mind to the members and communities we serve. Arkansas Blue Cross and Blue Shield is an Independent Licensee of the Blue Cross and Blue Shield Association.
