Job Description

Join Our Team: Do Meaningful Work and Improve People\xe2\x80\x99s Lives

Our purpose, to improve customers\xe2\x80\x99 lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.

To better serve our customers, we\xe2\x80\x99re creating a culture that promotes employee growth, collaborative innovation, and inspired leadership.

because we are committed to creating an environment where employees can do their best work and where best-in-class talent comes, stays, and thrives!

The Claims Processor II is responsible for the accurate and timely review, research, and resolution of moderately complex claims in accordance with contracts and policies. Incumbent is responsible for interpreting procedures and policies to ensure accurate claims resolution. May also be responsible for processing simple and routine claims.

What you will do:

• Review, process, and resolve moderately complex claims in accordance with contracts and policies.
• Research claims through the utilization of reference materials and on-line tools.
• Responsible for accurately coding claims through the system.
• Translate data into information acceptable to the claims processing system including follow up on pended claims.
• Maintain all appropriate claims files and perform follow-up on pended claims.
• Prepare claims for return to Provider or Subscriber when additional information is needed.
• Demonstrate adjudication proficiency to meet or exceed accuracy goals.
• Consistently meet cycle time/productivity goals that are aligned with corporate objectives.
• Maintain confidentiality of all documents/files.
• Contact other carriers or provider offices as necessary.
• May provide `buddy training\' and feedback to new associates.
• May complete adjustments, reversals, and/or refunds.
• Apply commitment to quality by doing things right the first time in order to avoid defects from reaching customers or requiring internal re-work.

What you will bring:

• High School diploma or GED. (Required)
• Six (6) months claims processing experience or Twelve (12) months dental clinical experience when applying for a position in the Dental Review team. (Required)
• BlueCard processing experience preferred.
• COB processing experience preferred.
• Facets processing experience preferred.

What we offer

• Medical, vision and dental coverage
• Life and disability insurance
• Retirement programs (401K employer match and pension plan)
• Wellness incentives, onsite services, a discount program and more
• Tuition assistance for undergraduate and graduate degrees
• Generous Paid Time Off to reenergize
• Free parking

Equal employment opportunity/affirmative action:

Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.

If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at careers@premera.com or via phone at 425-918-4785.

Premera is hiring in the following states, with some limitations based on role or city: Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin.

The pay for this role will vary based on a range of factors including, but not limited to, a candidate\xe2\x80\x99s geographic location, market conditions, and specific skills and experience.

National Salary Range: $35,700.00 - $53,500.00

National Plus Salary Range: $40,300.00 - $60,500.00

*National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska.

Premera Blue Cross