Claims Payment Specialist

Job Description

Job Description

Who we are.

At Blue Cross Blue Shield Global Solutions℠ (BCBS Global Solutions℠), 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's 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 Payment Specialist:

You're someone who enjoys solving problems, investigating details, and ensuring payments are handled accurately from start to finish. You thrive in a process-driven environment and take pride in delivering a positive experience for members, providers, and internal partners. You're naturally curious, organized, and committed to finding solutions when payment issues arise.

You're someone who:

• Has a strong attention to detail and enjoys researching discrepancies
• Takes ownership of issues and follows through to resolution
• Communicates effectively with customers, providers, and cross-functional teams
• Balances quality, accuracy, and productivity in a fast-paced environment
• Enjoys uncovering root causes and improving outcomes through problem-solving
• Can navigate multiple systems and processes while maintaining organization and accuracy

Here's the work you'll be doing to support claims payment operations: Payment Investigation & Resolution

• Analyze returned, rejected, suspended, and failed claim reimbursements to determine the cause of payment issues
• Review payment and claims information to identify discrepancies and ensure accurate reimbursement processing
• Research and resolve payment exceptions by updating electronic payment details and mailing information
• Coordinate the reissuance of claim payments after validating corrective actions

Member, Provider & Internal Partner Support

• Contact members and healthcare providers to obtain accurate payment information and address updates
• Serve as a liaison between Claims, Finance, Customer Service, and other internal teams to facilitate payment resolutions
• Request and monitor wire tracers and other payment investigations to support inquiries and issue resolution
• Maintain professional, timely communication with internal and external stakeholders throughout the resolution process

Refund Processing & Financial Accuracy

• Review and analyze refund payments received from members and providers related to overpayments or incorrect reimbursements
• Partner with appropriate teams to ensure proper claim credits and payment adjustments are processed
• Document findings, actions taken, and outcomes to support audit and compliance requirements
• Help ensure payment activity aligns with company policies, procedures, and service standards

Quality, Compliance & Continuous Improvement

• Maintain departmental productivity and quality standards
• Accurately document payment research, decisions, and supporting information
• Identify trends, recurring issues, and opportunities for process improvements
• Support departmental initiatives and other responsibilities as assigned
• Follow all company policies, procedures, and regulatory requirements

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

• You have a high school diploma or equivalent; additional education or coursework is a plus
• You have 1-2 years of experience in a customer-facing, administrative, claims, finance, accounting, or operations-related role
• You have strong organizational, problem-solving, and data entry skills
• You're comfortable making decisions based on research and supporting documentation
• You communicate clearly and professionally, both verbally and in writing
• You are proficient with Microsoft Office and comfortable learning new systems and technologies
• You can effectively manage multiple priorities while maintaining accuracy and attention to detail

Bonus points if you have:

• Experience with health insurance claims or payment processing
• Exposure to accounting, finance, or reimbursement functions
• Experience working with CRM, claims administration, or payment systems
• Knowledge of healthcare reimbursement processes
• Experience working in a regulated or compliance-focused environment
• Experience supporting remote or cross-functional teams

What you'll get in return:

• Competitive base pay + annual bonus
• Competitive medical plans
• Telemedicine services
• Paid parental leave
• 24/7 employee assistance and wellness support
• Free international healthcare coverage

Other great perks:

• Hybrid work model (office and/or remote)
• Work-abroad arrangements available
• Generous PTO accrual with carry-over options
• 9 paid holidays, plus one floating holiday and one volunteer day
• Tuition reimbursement
• Career development and learning opportunities
• 401(k) with generous company match
• Pet insurance options
• Identity theft and legal coverage
• Ongoing focus on well-being, including virtual wellness resources and mindfulness events

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

 

EOE