Fully Remote Claim Processor-Healthcare
ADP
If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.
Claims Analyst
Regular Full-Time Professional King of Prussia, PA, US
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.
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
Thrives in a fast-paced environment where priorities and workloads may shift
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
Stay current on policy updates, claim procedures, and industry regulations
Support special projects and additional responsibilities as assigned
The Claims Analyst will be expected to drive positive outcomes through:
Accurate and timely claim processing
Strong productivity and quality performance
Effective use of coding and claim adjudication knowledge
Delivery of an exceptional member experience through accurate claim resolution
You have a high school diploma or equivalent; 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 are comfortable making informed decisions and documenting claim determinations
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
Competitive medical plans
Free international healthcare coverage
Hybrid and remote work opportunities where applicable
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.
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