Claims Examiner
Blue Cross Blue Shield of Kansas
Wichita, Kansas
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JOB DETAILS
LOCATION
Wichita, Kansas
POSTED
5 days ago
You Belong At Blue
Why Join Us?
- Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
- FamilyComes 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.
- Base compensation is only one component of your competitive Total Rewards package
- Incentive 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 resources
Job 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 verification
- Accurately 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 Processing:
- Enter 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.
- Communication:
- Correspond with healthcare providers, patients, and internal departments to clarify or resolve discrepancies.
- Problem Resolution:
- Investigate and resolve complex or escalated claim issues, such as coding errors, benefit misunderstandings, or billing discrepancies.
- Compliance and Documentation:
- Ensure compliance with state and federal healthcare regulations.
- Maintain detailed and accurate records of all claims processed, including documentation for audits or reviews.
- Efficiency and Quality:
- Meet 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,
About the Company
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