BlueCross BlueShield of Tennessee Claims Trainee Class - PIO (Multiple Positions) in Chattanooga, Tennessee

This position is responsible for processing claims for a variety of products in an accurate and timely manner. In addition, this position generates daily reports and is responsible for other duties assigned by the supervisor. This position can progress to Claim Expert (5009) based on competencies. In an effort to help ensure the success of our employees and highest level of service to our members, BlueCross BlueShield of Tennessee provides a comprehensive training program for this position. Each examiner is expected to successfully complete a training program lasting up to 18 weeks, which provides detailed classroom and on-the-job training. The number of weeks could vary based on business need. Participation and attendance are mandatory.

Job Description:

Job Duties & Responsibilities

  • Adjudicate all claims to completion or returns to provider or member for additional or missing information
  • Process claims accurately and timely in support of MTM or other performance measures
  • Handle all claim edits appropriately including possible duplicates, eligibility status, corrected bills, manual pricing when appropriate, provider screen messages, authorizations, pre-existing condition, big bill guidelines, etc.
  • Administer benefits according to Benefit Summary and or Online Help (OLH) processing guidelines
  • If necessary, route problem claims to TTE, Supervisor, CARR, UM or Case Management, COB, Subrogation Unit, etc.
  • Compile processed claims in a processed folder with processor number and date in the secure paid claims department file for verification, quality and records storage when appropriate
  • Ensure timely and accurate completion of daily/weekly reports
  • Stay up-to-date regarding online resources, such as Online Help, BlueAlert, Medical Policy, and all other electronic resource changes when applicable
  • Keep abreast of changing divisional guidelines and government regulations
  • Recognize cause of problem and effect of resolution
  • Perform miscellaneous projects as assigned
  • Work overtime as required

Job Qualifications

Education

  • High School Diploma or equivalent required

Experience

  • Claims processing and/or customer service experience preferred
  • Customer service experience inclusive of restaurant, retail and/or insurance experience is acceptable
  • If current employee with the company, must meet minimum performance expectations
  • Previous health care experience is preferred

Skills/Certifications

  • Microsoft Office products knowledge desired
  • Effective oral communication and interpersonal skills
  • Good written communication skills
  • Sound decision-making and problem-solving skills
  • Exceptional organizational and time management skills
  • Must be able to key 6500 keystrokes per hour with less then 10% error rate (if applicable)
  • Must be able to pass required testing.

Job Specific Requirements:

Number of Openings Available:

0

Worker Type:

Employee

Worker Sub-Type:

Regular

Company:

BCBST is an Equal Opportunity employer (EEO), and all employees and applicants will be entitled to equal employment opportunities when employment decisions are made. BCBST will take affirmative action to recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or membership in a historically under-represented group.

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

Tobacco-Free Hiring Statement

To further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire individuals who use tobacco or nicotine products (including but not limited to cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, gum, patch, lozenges and electronic or smokeless cigarettes) in any form in Tennessee and where state law permits. A tobacco or nicotine free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community. All offers of employment will be contingent upon passing a background check which includes an illegal drug and tobacco/nicotine test. An individual whose post offer screening result is positive for illegal drugs or tobacco/nicotineand/or whose background check is verified to be unsatisfactory, will be disqualified from employment, the job offer will be withdrawn, and they may be disqualified from applying for employment for six (6) months from the date of the post offer screening results.

Resources to help individuals discontinue the use of tobacco/nicotine products include smokefree.gov or 1-800-QUIT-NOW.

About Us

As Tennessee's largest health benefit plan company, we've been helping Tennesseans find their own unique paths to good health for over 65 years. More than that, we're your neighbors and friends – fellow Tennesseans with deep roots of caring tradition, a focused approach to physical, financial and community good health for today, and a bright outlook for an even healthier tomorrow.