Claims Specialist II

High school diploma required 3-5+ years of claims processing experience 2+ years of BCBS claims processing experience Strong interpersonal and communication skills Strong attention to detail, with high degree of accuracy and urgency Ability to take initiative and ownership of assigned tasks, working independently with minimal supervision, yet maintain a team-oriented and collaborative approach to problem solving Previous success in a fast-paced environment

Carefully research discrepancies, process returned checks, issue refunds, and manage stop payments. Manage high-importance claims and vendor billing with urgency and attention to detail. Review and reply to appeals, inquiries, and other communications related to claims. Work with third-party organizations to secure payments on outstanding balances. Process case management and utilization review negotiated claims. Spot potential subrogation claims and escalate them appropriately. Actively contribute to team success by assisting colleagues, sharing knowledge, and fostering a collaborative environment.