All about us
You likely know us as an insurance company, but that’s just a portion of what we do. Hundreds of thousands of North Dakotans trust us to provide them with personalized service and unmatched access to care. It’s a mission we take seriously.
We also work with entities throughout the state to challenge the cost and complexity of health care in North Dakota. This uncompromising goal requires caring, innovative people who are ready and willing to help create a new level of health and well-being in North Dakota and beyond.
Work environment
This position has the flexibility to be a remote, hybrid or in-office work arrangement. We empower our employees to find a work style that is best for them. Learn more at Life at Blue | BCBSND.
Pay information
Pay Level: 015
FLSA Category: Non-Exempt Hourly
This position is eligible for internal and externa applicants.
A day in the life
The Claims Research Specialist is responsible for using knowledge to conduct research on complex claims and benefits issues and adjust appropriate claims. This role identifies trending issues within claims processing and assists with frontline resolution to ensure that questions or concerns are resolved in a timely manner. This position works directly with various internal departments and external entities to resolve questions pertaining to claims and benefits. This position will work within Medicaid Expansion.
Your responsibilities will include:
- Conducts in-depth research on claims and benefits issue requests received through internal systems.
- Reviews claims errors to determine if it’s a system or manual error, documents research outcomes and adjusts claims per benefits policies and procedures, if necessary.
- Follows up with appropriate individuals or areas to gather additional information to remedy issues. Clearly documents sources and validates the accuracy of data/information to resolve inconsistencies.
- Acts as resource and support for internal departments and management on issues involving claims and benefits.
- Assists various departments with frontline phone inquiries in attempt to resolve questions on initial contact.
- Identifies provider inquiry patterns and internal performance issues then communicates concerns to management and/or appropriate team.
- Processes Medicare crossover adjustment claims and determines if adjustments are needed.
- Researches various specialized requests for the Centers for Medicare and Medicaid Services (CMS) including but not limited to: the verification of a member’s Medicare coverage, identifying and reviewing claims processed by Medicare and Blue Cross Blue Shield of North Dakota, determining appropriate payments to Medicare and processing appropriate claims, communicating with CMS to provide time-sensitive information and collaborating with external collection agencies and internal staff as needed.
- Completes requests generated from reports and various departments in the organization resulting from systems issues, fraudulent payments or changes in processes.
What you need to succeed
- High School Diploma or GED
- 1 year of customer service in an office-setting or similar.
- Good communication skills to use with our members and other team members.
- Attention to the details to ensure work is accurate.
- Ability to problem solve and work to find resolutions.
- Have a task and goal focused work style.
Equivalent combination of education, experience or training determined to be acceptable by Human Resources may be substituted, unless regulated by contract or program standards
Benefits and perks
- Wellness incentives including well-being lifestyle spending accounts, employee assistance program and employee discounts.
- Encouraged paid time off including paid holidays and flexible holidays to use as you wish.
- 16 hours of paid volunteer time with a $200 donation to a charity of your choice upon completion of all volunteer hours.
- Employee recognition, community initiative events and yearly company outings.
- Workplace flexibility offering remote, office or hybrid work schedules and the freedom to make time for important commitments.
- Our core benefits include health, dental, vision and life insurance, short-term and long-term disability and paid parental leave.
Job posting policy
Employees new to Blue Cross Blue Shield of North Dakota are eligible to apply for positions within their assigned department after successfully completing 90-days in their role. For positions outside of their department, new employees should attain a minimum of six months of service before applying for a new role. Exceptions to this are acceptable, provided there is good business justification for making the move.
Equal opportunity employment
Equal Opportunity Employer of Minorities, Females, Protected Veterans and Individual with Disabilities, as well as Sexual Orientation or Gender Identity.
For questions, please email careers@bcbsnd.com.
This job posting will be closed 12/19/2022 at 8:00 a.m. (CT). No further applications will be considered.