Claims Processor, Intermediate Jobs

Your Role
The BSC Promise Health Plan team processes Medi-Cal Benefit claims. The Intermediate Claims Examiner will report to the Supervisor and Manager. In this role you will process claims and work special projects as assigned.
Your Work
In this role, you will:

• Given special processing assignments; coordinates with other departments for resolution if needed
• Be experienced in back-end processing; proficient in resolving complex edits using available documents/job aids with minimum direction
• Experience front-end processing and difficult adjustments
• Reviews and adjudicates complex/specialty paper/electronic claims
• Knowledge of Medi-Cal and benefit plans
• Determines whether to return, deny, or pay claims following organizational policies and procedures
• Be given special processing assignments; coordinate with other departments for resolution if needed
• Perform established performance metrics
• Understand fundamentals of end-to-end (life of a clam) claims processing

Qualifications
Your Knowledge and Experience

• Requires basic knowledge of systems and procedures and obtained through prior work experience or education
• Requires at least 3 years of experience
• Intermediate/Advanced skills creating documents/files using: Excel, Outlook, Power Point, and Word
• Requires basic job knowledge of systems and procedures obtained through prior work experience or education
• Requires a high school diploma or GED

Pay Range:
The pay range for this role is: $ 18.07 to $25.30 for California.
Note:
Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.
About Us
At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. We're excited to share Blue Shield of California has received awards and recognition for LGBT diversity, quality improvement, most influential women in corporate America, Bay Area's top companies in volunteering & giving, and one of the world's most ethical companies. Here at Blue Shield of California, we're striving to make a positive change across our industry and the communities we live in , Join us!