Claims Examiner

Capital Blue Cross

. Code and enter imaged claims and triage adjustments submitted by members, providers, and vendors .

Posted 11/6/2026full-timeRemote • Pennsylvania • United StatesMid-LevelSenior💰 $16 - $28 per hourWebsite

Core Competencies

Role fit

Core Competencies

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

Demonstrates proficiency in claims processing, including knowledge of ICD-10CM codes and provider billing documents, while maintaining high attention to detail and effective communication skills. Capable of adapting to changing priorities and managing workload efficiently within established timeframes.

Highest-signal resume keywords

ICD-10CM Diagnosis CodingClaims ProcessingAttention To DetailMicrosoft Office ProficiencyEffective Communication

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 CodingClaims Payment PoliciesManual Claims ProcessingAutomated Claims ProcessingBasic Reading SkillsBasic Arithmetic SkillsKeyboarding SkillsImage Systems KnowledgeProvider Billing Documents FamiliarityTime Management Skills

Soft Skills

DependabilityProfessionalismInitiativeTeamworkAdaptability

Tools & Technologies

Microsoft WindowsEmailInternet BrowsersInstant MessengerWorkDesk ImagingFACETS Claims CodingFACETS Claims ProcessingFACETS Customer Service Application

Industry Keywords

Claims Processing ProceduresCoverage LimitationsContract SpecificationsError PreventionDiversity Inclusion

About the role

Key responsibilities & impact

Code and enter imaged claims and triage adjustments submitted by members, providers, and vendors
Review and correct online edit errors by interpreting warning messages
Use appropriate systems and reference documents to research and accurately process claims
Make coding and payment decisions based on imaged claims and applicable documentation
Review and process claims in pending status according to procedures, policies, contract specifications, coverage, limitations, and exceptions
Identify and report possible system or image problems to CPR or a Supervisor
Perform other duties and assignments as directed

Requirements

What you’ll need

Must have a high school diploma or GED
Ability to communicate effectively and professionally in written and verbal form
Strong attention to detail and interest in preventing errors
Ability to operate a personal computer and office equipment
Excellent keyboarding skills
Dependable and professional
Initiative and time management skills
Commitment to teamwork and ability to foster an inclusive culture of diversity
Ability to accept feedback, learn, and adapt
Ability to adapt to changing priorities
Ability to manage workload and complete tasks within established timeframes
Basic reading and arithmetic skills
Preferred familiarity with provider billing documents
Preferred familiarity with medical terminology and ICD-10CM diagnosis, procedure, ancillary, type of service, and qualifier codes
Preferred knowledge of manual and automated claims processing and Image systems
Preferred knowledge of claims payment policies and benefits
Preferred proficiency with Microsoft Windows, Email, Internet browsers, Instant Messenger, and Microsoft Office
Preferred FACETS claims Coding
Preferred Facets claims processing
Preferred WorkDesk Imaging
Preferred Facets Customer Service Application
Must be willing and able to work possible mandatory overtime
Must be able to meet quality, productivity, and behavior expectations

Benefits

Comp & perks

Medical, Dental & Vision coverage
Retirement Plan
Paid Time Off
Holidays
Volunteer time off
Incentive Plan
Tuition Reimbursement
Training and continuing education
Flexible environment
Community volunteering opportunities