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 according to divisional quality and productivity standards.

Posted 10/12/2026full-timeRemote • United StatesJunior💰 $20 - $26 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical claims processing, including data entry, benefit eligibility determination, and adherence to quality standards. Proficient in utilizing medical coding systems and maintaining confidentiality while ensuring compliance with corporate guidelines.

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 Experience

Soft Skills

Interpersonal SkillsSound JudgementDecision MakingTeamworkDependability

Tools & Technologies

Claims Processing SystemComputer SystemsCorporate ManualsProfessional Manuals

Certifications & Qualifications

Claims Assessment Proficiency

Industry Keywords

Medical ClaimsHealth InsuranceConfidentialitySegregation of DutiesAnatomy

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 according to divisional quality and productivity standards.
Investigate claims and communicate to obtain necessary information to complete claims.
Enter data into the claims system.
Review and interpret contract benefits.
Conduct edit and audit resolution.
Determine benefit eligibility.
Identify and research processing issues through 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 levels.
Use corporate and professional manuals and guidebooks, including the company processing manual 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.