Claims Analyst

Claims Analyst

At Blue Cross Blue Shield Global Solutions SM (BCBS Global Solutions SM ), we make it easy for people and organizations to access and pay for healthcare abroad. By combining digital innovation with human-centered care, we go above and beyond for our customers and deliver an international healthcare experience that is simple, efficient, and human.

Whether our customers live, work, travel, or study abroad, we give them the confidence and peace of mind to say yes to new possibilities.

What we're looking for in our Claims Analyst:

You're a detail-oriented problem solver who enjoys analyzing information and ensuring healthcare claims are processed accurately and efficiently. You understand that behind every claim is a member seeking support, and you're committed to delivering quality outcomes that help members access the benefits they deserve.

You're someone who:

• Has a passion for accuracy and consistently delivers high-quality work
• Enjoys research and investigation to understand complex claim scenarios
• Can confidently interpret healthcare and insurance information
• Balances productivity with attention to detail
• Thrives in a fast-paced environment where priorities and workloads may shift
• Communicates effectively and collaborates well with teammates and business partners
• Takes ownership of their work and is committed to continuous learning and improvement

Here's the work you'll be doing to support our members around the world:

Claims Analysis & Processing

• Review and analyze international healthcare claims to determine services rendered, charges, and eligibility for payment
• Investigate claim details and gather necessary information to ensure accurate adjudication and processing
• Maintain complete and accurate claim documentation and records
• Translate international medical invoices and supporting documentation when appropriate

Claims Adjudication & Coding

• Process claims according to benefit plans, policy provisions, and established claim handling procedures
• Apply appropriate medical coding standards, including ICD-10, CPT, and Place of Service coding when required
• Ensure accurate data entry and claim setup to facilitate proper claim adjudication and settlement
• Process claims in accordance with specific program requirements, including Classic, BCBS Global Core, and FEP business lines

Quality & Performance Excellence

• Meet departmental productivity, accuracy, and quality standards
• Adhere to service level agreements and claim processing requirements
• Identify trends, discrepancies, or issues that may impact claim outcomes
• Escalate concerns and collaborate with leadership to resolve claim-related challenges

Collaboration & Continuous Improvement

• Partner with peers and cross-functional teams to support operational excellence
• Stay current on policy updates, claim procedures, and industry regulations
• Contribute ideas that improve efficiency, accuracy, and the overall member experience
• Support special projects and additional responsibilities as assigned

What success looks like:

The Claims Analyst will be expected to drive positive outcomes through:

• Accurate and timely claim processing
• Strong productivity and quality performance
• Consistent adherence to service level commitments
• Effective use of coding and claim adjudication knowledge
• Positive collaboration with internal partners and team members
• Delivery of an exceptional member experience through accurate claim resolution

This might be the right fit for you if...

• You have a high school diploma or equivalent; additional education is a plus
• Your resume includes 3+ years of health insurance claims processing, adjudication, or related experience
• You have experience reviewing medical claims and interpreting benefit plans
• You possess strong analytical, organizational, and problem-solving skills
• You are comfortable making informed decisions and documenting claim determinations
• You have strong written and verbal communication skills
• You can effectively manage multiple priorities while maintaining attention to detail
• You are proficient with Microsoft Office and comfortable learning new systems and technologies

Bonus points if you have:

• Experience processing international medical claims
• Knowledge of BCBS Global Core or Federal Employee Program (FEP) claims
• Familiarity with CPT, ICD-10, and medical coding practices
• CPC, CCS, or other coding certifications
• Experience with automated claims adjudication platforms
• Health insurance industry expertise, particularly in international healthcare
• Blue Cross Blue Shield experience

What you'll get in return:

• Competitive base pay
• Competitive medical plans
• Telemedicine services
• Paid parental leave
• Employee assistance and wellness support
• Free international healthcare coverage

Other great perks:

• Hybrid and remote work opportunities where applicable
• Generous PTO
• Paid holidays, floating holiday, and volunteer day
• Tuition reimbursement
• Career development opportunities
• 401(k) with company match
• Pet insurance, identity theft, and legal coverage

Please visit the employee benefits page on our website for more information on our benefits and perks that support your overall well-being.

EOE