Claims Specialist

Arkansas Blue Cross and Blue Shield

. Resolve medical claims that are not automatically adjudicated by the claims processing system in a timely and accurate manner .

Posted 10/28/2026full-timeRemote • United StatesJuniorWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in medical claims processing, including investigation, data entry, and benefit eligibility determination. Proficient in using coding manuals and maintaining confidentiality while adhering to corporate standards.

Highest-signal resume keywords

Claims ProcessingMedical TerminologyData EntryOral & Written CommunicationsDetail-Oriented

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AdjudicationBenefit Eligibility DeterminationEdit and Audit ResolutionICD CodingCPT CodingHCPCS CodingData AnalysisOffice ExperienceProficiency Test: Claims Assessment

Soft Skills

Strong Interpersonal SkillsSound JudgementDecision MakingTeamworkDependability

Tools & Technologies

Claims Processing SystemComputer SystemsProcessing ManualsCorporate Manuals

Industry Keywords

Health InsuranceMedical OfficeAnatomyBiologyConfidentialitySegregation of Duties

About the role

Key responsibilities & impact

Resolve medical claims that are not automatically adjudicated by the claims processing system in a timely and accurate manner
Investigate claims and communicate to obtain necessary information
Enter data into the claims system
Review and interpret contract benefits
Conduct edit and audit resolution
Determine benefit eligibility
Identify and research processing issues using systems and manuals
Route claims to other areas
Consult internal staff and medical providers
Generate correspondence and complete forms to obtain necessary information
Complete initial training, on-the-job training, and continuing education
Access relevant computer systems and screens to process claims accurately
Stay current with changing processing procedures, benefits, and system modifications
Meet corporate and national (MTM) standards while maintaining departmental productivity and quality standards
Use corporate and professional manuals and guidebooks, including processing manuals and ICD, CPT, and HCPS codebooks
Perform other duties as assigned

Requirements

What you’ll need

High School diploma or equivalent
Minimum two (2) years' college coursework (48 semester hours) or other equivalent certification with an emphasis in anatomy, medical terminology, math, biology, or a related field, OR minimum one (1) year of related office experience such as claims processing, health insurance, or medical office
Must pass company proficiency test: Claims Assessment
Oral & Written Communications
Strong Interpersonal skills
Sound Judgement
Decision Making
Detail-Oriented
Teamwork
Dependability
Must ensure the security and confidentiality of records and information
Must adhere to segregation of duties guidelines in the Administrative Manual

Benefits

Comp & perks

Work from home within Arkansas, Washington, Oregon, Utah, Idaho, North Dakota, or Minnesota
Initial training, on-the-job training, and continuing education
Preference given to current employees and candidates residing in Arkansas, Utah, Idaho, and North Dakota