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Claims Specialist

Blue Cross Blue Shield of Kansas

Topeka, KS

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JOB DETAILS
SKILLS
Adjudication, Claims Management, Claims Processing, Communication Skills, Contract Analysis, Corrective Action, Financial Operations, Financial Reporting, Hospital, Insurance, Legal Documents, Maintain Compliance, Operational Improvement, Presentation/Verbal Skills, Product Development, Product Programs, Reconciliation, Regulations, Regulatory Compliance, System Test, Treatment Evaluation, Treatment Plan, Work From Home, Writing Skills
LOCATION
Topeka, KS
POSTED
1 day ago
This job was posted by https://www.kansasworks.com : For more information, please see: https://www.kansasworks.com/jobs/13585195 **Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.** **Why Join Us?** - **Make a Positive Impact:** Your work will directly contribute to the health and well-being of Kansans. - **Family** **Comes 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. **Benefits & Perks** - 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** The AICK Claims Specialist will administer, review, and approve or deny all types of claims, for the products marketed by AICK, to include Waiver of Premium, Term Life, Accidental Death & Dismemberment, Short Term Disability, Long Term Disability, Living Benefit Rider, Ordinary Life, Yearly Renewable Term, all Voluntary Life and Accidental Death & Dismemberment coverage. This position also plays a part in helping develop new products, answering questions regarding how the provisions of a policy are administered and serving on Ad Hoc teams representing AICK as needed. \"This position is eligible to work hybrid 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** - Review, investigate, and adjudicate all claims (approval or denial) by verifying eligibility, coverage, and contract provisions, including obtaining additional information from employers, hospitals, reinsurers, and other external partners. - Ensure claim handling complies with all regulatory requirements, including ERISA, NAIC unfair claims practices, and applicable state regulations, and that claims are processed within statutory timeframes with appropriate documentation. - Interpret and apply policy provisions, reinsurance treaties, and group contracts to determine claim payability, reinsurer liability, and continuation of liability; partner with reinsurers to confirm determinations. - Conduct in-depth investigations on complex or questionable claims, including coordinating with investigators or rehabilitation specialists and preparing documentation for potential legal proceedings when required. - Manage disability claims lifecycle, including review and processing of continuance requests, evaluation of treatment plans, and assessment of rehabilitation or return-to-work options. - Communicate claim decisions and policy provisions clearly to claimants, employers, attorneys, and regulatory bodies via phone and written correspondence, including responses to denials and inquiries. - Manage overpayment recoveries and collections, including establishing and monitoring repayment arrangements with claimants. - Maintain accuracy of claim account and systems by verifying reports, reconciling balances, making necessary adjustments, and approving claims for payment per guidelines. - Research and respond to State Insurance Department complaints, implement corrective actions as needed, and maintain required complaint logs in compliance with regulatory standards. - Support contract updates and product development initiatives by collaborating across departments, participating in Ad Hoc teams, and identifying operational or compliance improvement opportunities. - Compile and report required financial and operational data, including Schedule F for the Annual Statement, management reports (e.g., claim processing time, paid claims, closed claims), and other required reporting (FICA, W-2/W-3). - Participate in system testing for claims payment platforms, including validation of new releases and defect fixes. **What you need** **Knowledge/Skills/Abilities** Ability to analyze detailed contract provisions and make decisions based on a set of facts or criteria. Excellent written and verbal communication skills. Extensi

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Blue Cross Blue Shield of Kansas