• Claims Adjuster I - MD/DC (Remote)

    CareFirst (Baltimore, MD)


    Resp & Qualifications

    PURPOSE:

    Investigate and perform adjustment of claims and ensure that claims are handled properly within authority limits, and in line with standard procedures and guidelines. Verifies insurance claims by reviewing claims requirements; examining documentation and calculations; highlighting and summarizing out-of-line situations; recommending changes in operating processes; completing reports, logs, and audit records.

     

    *Although this position is REMOTE, candidates must live in the MD/DC area in order to travel as needed to the nearest CareFirst Office.

    ESSENTIAL FUNCTIONS:

    + Proactively investigate and perform adjustments of claims. Ensure claims are handled within authority limits, and in line with standard procedures and guidelines.

    + Updates claims audit records by entering, verifying, and securing data.

    + Settle standard/complex claims through payment or denial.

    + Provides claims audit information and reports by collecting, analyzing, and summarizing data and trends.

    + Improves claims adjustment job knowledge by attending training sessions

    QUALIFICATIONS:

    **Education Level:** High School Diploma or GED.

    **Experience:** 3 years claims experience and complete understanding of all systems, policies and procedures.

    **Preferred Qualifications** :

     

    Above Target performance rating preferable.

    Knowledge, Skills and Abilities (KSAs)

    + Ability to analyze information gathered from investigation.

    + Excellent communication skills both written and verbal.

    + Ability to recognize, analyze, and solve a variety of problems.

    + Skill in completing assignments accurately with attention to detail.

     

    Salary Range: $36,144 - $66,264

     

    Salary Range Disclaimer

     

    The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

     

    Department

     

    Medicare/Medicaid Claims

     

    Equal Employment Opportunity

     

    CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

     

    Where To Apply

     

    Please visit our website to apply: www.carefirst.com/careers

     

    Federal Disc/Physical Demand

     

    Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

    PHYSICAL DEMANDS:

    The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

     

    Sponsorship in US

     

    Must be eligible to work in the U.S. without Sponsorship.

    \#LI-AB1

    REQNUMBER: 21445