Claims Specialist

Arkansas Blue Cross and Blue Shield

. Resolve medical claims that are not automatically adjudicated by the claims processing system .

Posted 10/8/2026full-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 effective communication with internal staff and medical providers. Proficient in utilizing claims processing systems and adhering to corporate standards for productivity and quality.

Highest-signal resume keywords

Claims ProcessingMedical TerminologyData EntryOral and Written Communication SkillsDetail-Oriented

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AdjudicationBenefit Eligibility DeterminationData EntryICD CodingCPT CodingHCPCS CodingAudit ResolutionContract Benefit ReviewClaims Assessment ProficiencyAnatomy Knowledge

Soft Skills

Interpersonal SkillsSound JudgmentDecision-Making SkillsTeamworkDependability

Tools & Technologies

Claims Processing SystemComputer SystemsProcessing ManualsCorporate ManualsGuidebooks

Industry Keywords

Health InsuranceMedical OfficeConfidentialitySegregation of DutiesContinuing Education

About the role

Key responsibilities & impact

Resolve medical claims that are not automatically adjudicated by the claims processing system
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 through systems and manuals
Route claims to other areas
Consult internal staff and medical providers
Generate correspondence
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 for productivity and quality
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 and written communication skills
Strong interpersonal skills
Sound judgment
Decision-making skills
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