Claims Adjuster Healthcare REMOTE

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.
We are hiring for a Claims Adjuster to join the team! The Claims Adjuster analyzes and processes requests and inquiries for adjustments to medical insurance claims in an accurate and timely manner while adhering to claims processing standards and Service Level Agreements. This position must be able to adequately communicate findings and be able to assist with escalated issues, and special projects.
Performs retrospective claim adjustments that include identifying overpayments, underpayments, system configuration issues and correcting as appropriate.
Analyze external and internal inquiries to identify required claim adjustments.
Process claims as needed by analyzing international claims to identify the claimant, type of services rendered and charge for each and comparing each claim to customer’s policy coverage provisions.
Communicate claim adjudication and/or adjustment analyses to internal departments, internal teams, members, and providers.
Accurately process medical claim adjustments into the claims system in adherence to BCBS Global SolutionsSM /HTH standards.
Reporting error trends that are detected for future educational training purposes.
Maintaining required departmental production and quality standards.
Keep Manager advised of status of workload and identify problems for which help is needed.
Follow regulations and company rules and policies as outlined in the Employee Handbook.
High school diploma or equivalent required. Minimum - three years of experience in the health insurance industry examining and adjudicating medical claims preferably with exposure to stating plan features and benefits and helping to resolve claims related issues.
Familiarity with insurance products and insurance terminology, including CPT and ICD-9 coding. Excellent verbal and written communication skills and ability to effectively deal with customer complaints and concerns.
Microsoft Office Products, Internal software systems, the internet and overall familiarity with personal computers is required, as well as the ability to work with dual computer monitors preferred.
Salesforce experience a plus.
Flexibility to work in an office and/or at-home, remote office environment.
Overtime and/or schedule flexibility are occasionally necessary in this position. Must be able to communicate internally and externally through receiving and responding to auditory and visual methods.

Competitive base pay + annual bonus

• Competitive medical plans
• Free international healthcare coverage

• 9 paid holidays, plus one floating holiday and one volunteer day
• Tuition reimbursement
• Pet insurance options
• Identity theft and legal coverage
• Ongoing focus on well‑being, including virtual wellness resources and mindfulness events