Claims Examiner II

Blue Cross and Blue Shield of Nebraska

. Adjudicate healthcare claims using employer- and payer-specific policies and procedures .

Posted 10/27/2026full-timeRemote • Nebraska • United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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

Demonstrates expertise in healthcare claims adjudication, including analyzing claims for accuracy and compliance with CMS and billing guidelines. Proficient in collaborating with teams and utilizing multiple systems to enhance productivity and quality standards.

Highest-signal resume keywords

Claims AdjudicationCMS Guidelines ReviewMS Office ProficiencyProblem Resolution SkillsTeam Collaboration

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Claims ProcessingMedical Claim ReviewData AnalysisEligibility VerificationClaim Dispute Resolution

Soft Skills

Excellent Communication SkillsCreative ThinkingStrong Work EthicMulti-tasking Ability

Industry Keywords

Healthcare ClaimsBenefit CoverageProvider StatusClaim System ConfigurationQuality Trends

About the role

Key responsibilities & impact

Adjudicate healthcare claims using employer- and payer-specific policies and procedures
Review claims processing data against CMS and billing guidelines
Review medical claim attachments and documentation to determine medical appropriateness and benefit coverage
Review claim and line-item edits to determine appropriate payment
Forward claims to specialized internal and external resources when needed
Correspond with other departments to process claims
Meet performance metric scorecards and production and quality standards
Analyze complex claims for accuracy, completeness, benefits, eligibility, COB requirements, and provider status
Use multiple systems and screens to obtain and record claim information
Review claim disputes, including urgent internal department requests
Identify potential claim system or provider contract configuration issues and communicate them for correction
Provide feedback on quality trends and process improvement opportunities
Collaborate with teammates and business partners to achieve productivity and accuracy standards
Participate in special projects
Partner with less experienced associates to improve team and division knowledge and performance
Perform other duties assigned by Claims Leadership

Requirements

What you’ll need

High School degree
Proficiency as a Claims Examiner I or relevant healthcare experience
Excellent verbal and written communication skills
Proficiency with MS Office applications
Team collaborator
Must be able to work with minimal supervision
Creative thinker with good problem resolution skills related to healthcare claim adjudication
Strong work ethic with ability to multi-task when needed
Candidates applying to this remote position are required to live in the state of Nebraska or local Omaha metro area

Benefits

Comp & perks

Comprehensive Total Rewards package
Equal Opportunity / Affirmative Action Employer
Disability accommodation support