Claims Adjuster Blue Card-OPEIU

Company :
Highmark Inc.

Job Description : JOB SUMMARY Provides customers with complete, accurate and timely claims review and performs adjustments of claims relative to Blue Card claims administration and claims related tasks. This is a bargaining unit position. The collective bargaining agreement for this position requires that candidates and employees reside in the following counties in the State of New York:
Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, or Wyoming.

• Adjusts Blue Card claims under provisions of applicable contracts, provider operating agreements and corporate procedures through the performing of on-line transactions and /or adjustments utilizing the corporate claims administration system.
• Identifies potential fraudulent cases and forwards to Special Investigations Department for further review.
• Identifies opportunities to resolve issues on behalf of the customer, through process improvement requests.
• Provides necessary documentation to management for recommendations on changes in departmental procedures/desk levels.
• Initiates correspondence and/or telephone contact incidental to general claims administration/adjustments and/or assignments.
• Answers written and/or verbal inquires/correspondence from internal and/or external customers.
• Maintains accurate daily production records as needed.
• Maintains confidentiality and adheres to HIPAA regulations.
• Delivers service to internal and/or external customers in a professional, polite and efficient manner.
• Performs all job duties efficiently and at an acceptable rate of performance.
• Other duties as assigned or requested.

Required Healthcare or insurance related experience; claims processing experience; knowledge of medical terminology. Preferred Previous claims processing or equivalent experience.

• Must meet minimum qualifications to perform the job including satisfactory completion of all training and testing, inlcduing Basic Computer Literacy test, Typing
  
  Skills:
  
  30
  
  WPM, and Job Content test.
• Ability to multitask if fast paced environment.
• Well organized with ability to adapt to changing office environment; exhibits attention to details and time management skills.
• Proficiency in English language skills, including spelling, punctuation and grammar, in both written and verbal communication to ensure communications are issued in a professional manner Ability to utilize basic office equipment.
• Problem Solving. Identified issues and problems; identifies opportunities for improved claims processing.

Required High School/GED Preferred None

Required None Preferred None

None

0% - 25%

Position Type Office- or Remote-based Teaches / trains others Occasionally Travel from the office to various work sites or from site-to-site Rarely Works primarly out-of-the office selling products/services (sales employees) Never Physical work site required No Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely Disclaimer:
The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement:
This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information…