Claims Specialist

Blue Cross and Blue Shield of Louisiana

. Accurately process claims edits .

Posted 10/14/2026full-timeRemote • Louisiana • United StatesJuniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in processing medical claims, including coordination of benefits and applying provider reimbursement rules. Strong analytical and communication skills are essential for effective collaboration and resolution of claims-related issues.

Highest-signal resume keywords

Medical Claims ProcessingCoordination Of Benefits (COB)Claims AdjustmentMedical Billing CertificationAnalytical Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims EditsBenefit RecalculationProcessing CodesRefund RequestsContractual Benefits Application

Soft Skills

Oral CommunicationWritten CommunicationHuman Relations Skills

Tools & Technologies

PC Software

Certifications & Qualifications

Medical Billing Certification

Industry Keywords

Health InsuranceClaims ReviewQuality AuditsMedicareBackground Screening

About the role

Key responsibilities & impact

Accurately process claims edits
Determine primacy for Coordination of Benefits (COB)
Adjust previously paid claims and initiate procedures to recover overpaid funds
Review, research, and update claims, including benefit recalculation, claims edits, and refund requests
Apply contractual benefits and provider reimbursement rules
Identify denial, edit, and processing codes to correctly process coordinated and non-coordinated claims
Request medical records when required
Communicate with internal and external contacts regarding claims, COB, and medical record requests
Review quality audits and correct or route them within 48 hours
Research and determine the correct order of benefits and correct COB records
Notify appropriate departments when Medicare determines primacy incorrectly
Assist with training, implementations, documentation, and other assigned duties

Requirements

What you’ll need

High School Diploma or equivalent required
6 months of experience in medical claims or health insurance-related customer service, or successful completion of BCBSLA adjustment or COB training
Certification in Medical Billing or Coding can be used in lieu of experience
Strong analytical ability
Oral and written communication skills
Human relations skills
Working knowledge of relevant PC software
Must be authorized to work for Louisiana Blue in the United States without employer-sponsored immigration support
Residency in or relocation to Louisiana is preferred
Must successfully complete background and pre-employment drug screening

Benefits

Comp & perks

Employee resources to support health, learning, skill development, professional growth, and community service
Reasonable accommodations for individuals with disabilities
Smoke- and tobacco-free workplace
Background and pre-employment drug screening
Drug-free workplace