Claims Processor IV

This is a fully remote position, open to applicants in Alaska, +26 more states.

📋 Description

• Conduct thorough and timely reviews, research, and resolution of moderate to highly complex claims in accordance with contracts and policies.

• Input and manage all assigned claims until they are fully processed.

• Collaborate with various business units to address and resolve claims.

• Recognize procedural improvements and assist in updating processes and procedures.

• Offer specialized knowledge regarding complex claims to Care Facilitation, Customer Service, Appeals, benefit configuration, and other claims teams.

• Execute accumulator adjustments, load deductible credits, and carry out member history reviews.

• Reprocess carve-out claims, investigate claim history and contractual agreements, override specific claim edits, and finalize reprocessing documentation.

• Act as the subject matter expert within the team by training and auditing claims while providing constructive feedback and coaching.

• Undertake specialized projects, including auditing, procedure updates, and coordination with configuration.

• Achieve cycle-time and productivity targets that align with corporate goals.

• Convert data into formats suitable for the claims processing system and follow up on claims that are pending.

• Ensure the confidentiality of all documents and files is maintained.

• Implement quality standards to minimize defects and internal rework.

⛳️ Requirements

• High School diploma or GED (Required).

• A minimum of two (2) years of experience in claims processing within medical and/or dental plans, or two years of related experience in a medical and/or dental office or insurance industry (Required).

• Comprehensive knowledge of Premera processing systems.

• Demonstrated ability to audit the work of other processors.

• Familiarity with Out-of-area programs.

• Proficient in or experienced in another functional area of Premera (M & B, CSR, PIMS, PS&S, or Sales).

• Capable of typing and communicating clearly and understandably in person and over the phone.

• Ability to fulfill essential physical requirements with or without accommodation.

🏝️ Benefits

• Medical, vision, and dental insurance with low employee premiums.

• Optional benefit offerings, including pet insurance.

• Life and disability insurance coverage.

• Retirement plans, featuring a 401K employer match and a pension plan that vests after three years of service.

• Wellness incentives and mental health resources, including counseling, stress management, and mindfulness programs.

• Generous paid time off policy.

• Tuition assistance for undergraduate and graduate studies.

• Employee recognition initiatives.

• Commuter benefits.

• Complimentary convenient on-site parking.

• Subsidized on-campus dining options.

• On-site health and wellness programs.

• Fitness and well-being center offering both in-person and virtual workouts, along with nutritional counseling.

• Flexible on-campus schedule for hybrid employees, with access to on-site resources, networking opportunities, and team engagement activities.