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Durham, North Carolina, United States
Hybrid
Not Available
Job Description
We’re hiring a Claims Specialist to join the Claims Operations Team! With moderate supervision, the Claims Specialist reviews and timely adjudicates claims and administers them in accordance with contractual benefits and health care policies. The Claims Specialist drives an end-to-end service model that decreases handoffs and improves ownership across claims life cycle. The role is responsible for managing daily work queues, quality of claims processed and final resolution. Also monitors claim turnaround times to assure all compliance guidelines are met as well as performance guarantees. Claims reviewed are non-routine and are for any business segment and/or multiple claims-provider type.At Blue Cross NC, we’re making health care better for all – by listening deeply, challenging what’s possible, and putting care at the heart of everything we do. Join a purpose driven team where ideas spark change, growth is encouraged, collaboration fuels impact, and you’re supported with the flexibility and trust to do meaningful work.
What You’ll Do
What You Bring | Required Qualifications
At this time, Blue Cross NC will not sponsor employment authorization for this position.
Bonus Points | Preferred Qualifications
What You’ll Get
Where You’ll Work
Our Hybrid Flex approach is built on presence with a purpose – giving you flexibility to work remotely with intentional in-person connection – that supports a workplace that’s flexible, connected, and future focused.
In a Hybrid-Flex role, you’ll work in the office at least two days a week for collaboration and connection. In a Remote Flex role, you’ll work virtually, with a few in-office visits each year for meaningful moments that matter.
Whether your role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any states listed on this job posting. Onsite expectations will be discussed during the interview process.
Salary Range
At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.
*Based on annual corporate goal achievement and individual performance.
Skills
Claims Adjudication, Claims Analysis, Claims Management, Claims Operations, Claims Processing, Claims Resolution, Documentations, Health Insurance Processing, Insurance, Insurance Claim Handling, Insurance Claims, Insurance Claims Investigations, Insurance Claims Processing, Medical Claims Processing, Process Improvements, Workload Management_____________________________________________________________________
JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC. If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: HR.Staffing@BCBSNC.com.
