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Claims Examiner
Blue Cross and Blue Shield of Kansas. Review, analyze, and verify healthcare claims submitted by policyholders or medical providers .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in healthcare claims processing, including ICD-10, CPT, and HCPCS coding, while ensuring compliance with state and federal regulations. Strong organizational and communication skills are essential for resolving discrepancies and meeting performance targets.
Highest-signal resume keywords
Healthcare Claims ProcessingICD-10 CodingCPT CodingMedical TerminologyAttention to Detail
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims AnalysisEligibility VerificationData EntryPolicy Coverage ReviewCorrective Action Adjustment
Soft Skills
Organizational SkillsWritten CommunicationVerbal CommunicationCritical ThinkingProblem-Solving
Tools & Technologies
Office SoftwareComputer Systems
Industry Keywords
Healthcare RegulationsMedical BillingInsurance PoliciesClaims Records MaintenancePerformance Targets
About the role
Key responsibilities & impact- Review, analyze, and verify healthcare claims submitted by policyholders or medical providers
- Ensure documentation, ICD-10, CPT, HCPCS coding, and data are complete and accurate
- Check eligibility, coverage, and applicable benefits according to policy terms
- Enter and process claims information accurately in the system
- Apply deductibles, co-pays, co-insurance, and maximum coverage limits
- Approve or deny claims based on policy coverage and regulatory/company standards
- Adjust processed claims for corrective action
- Correspond with healthcare providers, patients, and internal departments to resolve discrepancies
- Investigate and resolve complex or escalated claim issues
- Ensure compliance with state and federal healthcare regulations
- Maintain accurate claims records for audits and reviews
- Meet individual and team performance targets for speed, accuracy, and quality
- Participate in ongoing training on policy and technology changes
- Monitor and work daily reports to ensure timely claim control
- Perform other assigned duties
Requirements
What you’ll need- High school diploma or equivalent required
- Reside in Kansas or Missouri, or be willing to relocate as a condition of employment
- Previous experience in healthcare claims processing, medical billing, medical terminology, or health insurance preferred
- Knowledge of medical claim processing, medical terminology, insurance policies, and coding standards (ICD, CPT)
- Strong attention to detail and organizational skills
- Excellent written and verbal communication skills
- Ability to work efficiently under pressure and meet deadlines
- Critical thinking and problem-solving skills
- Office and/or computer system experience preferred
- Subject to pre-employment drug screening, criminal conviction check, employment verifications, and education verification
Benefits
Comp & perks- Paid vacation and sick leave
- Paid maternity and paternity leave available immediately upon hire
- Incentive pay program (EPIP)
- Health, vision, and dental insurance
- 6 weeks paid parental leave for new mothers and fathers
- Fertility/adoption assistance
- 2 weeks paid caregiver leave
- 401(k) plan matching up to 5%
- Tuition reimbursement
- Health and fitness benefits, discounts and resources
- Ongoing training and development programs
- Flexible work environment
- Equal employment opportunities