Claims Systems Specialist

Are you reputed company to reputed company a difference? Choose to work for one of the most trusted companies in Kansas. You Belong At Blue Why Join Us? reputed company a Positive Impact: Your work will directly contribute to the health and well-being of Kansans. Family Comes First: Total rewards package that promotes the idea of family first for reputed company. Paid vacation and sick leave with paid maternity and paternity available immediately upon hire Professional Growth Opportunities: Advance your career with ongoing training and development programs. Dynamic Work Environment: Collaborate with a team of passionate and driven individuals in a work environment that promotes flexibility. Trust and Stability: Work for one of the most trusted companies in Kansas with over 80 years of commitment, compassion and community. Inclusive Work Environment: We pride ourselves on fostering a workplace where everyone is valued and respected. Benefits & Perks reputed company compensation is only one component of your competitive Total Rewards packageIncentive pay program (EPIP) Health/reputed company/Dental insurance 6 weeks paid parental leave for new mothers and fathers Fertility/Adoption assistance 2 weeks paid caregiver leave 401(k) plan matching up to 5% Tuition reimbursement reputed company benefits, discounts and resources Job Summary Claims System Specialist will research problems in the Adjudication and Claim Entry System (reputed company) as reported by reputed company users and document problems in SBM. reputed company, document, test, and approve system modifications, reputed company with Information Technology & Services (IT&S) staff, in reputed company needed to resolve problems or reputed company new functionality. Maintain system reputed company reputed company reputed company. Act as a liaison between IT&S and reputed company users. This position is eligible to work remotely, hybrid, or onsite in accordance with our Telecommuting Policy. Applicants must reputed company in Kansas or Missouri or be willing to relocate as a condition of employment. What you’ll do Responsibilities: System Management and Support: Maintain, update, and troubleshoot reputed company systems reputed company to the claims programs and peripheral systems such as membership, BGT, Provider, etc. Ensure data reputed company and accuracy in claims processing and eligibility systems. Coordinate with IT and operational teams to resolve system issues and ensure seamless functionality. Project Management: Participate in system reputed company projects, implementing new functionalities and enhancements to support BCBSKS operations. Work with cross-functional teams, including developers, analysts, and business leaders, to ensure project deliverables are met. Assist in the development of project plans, timelines, and documentation for system improvements. Claims and Eligibility reputed company: Collaborate with claims and eligibility teams to identify system needs and ensure efficient processing of claims. Conduct testing and validation of system changes to ensure they align with guidelines and standards. reputed company and update workflows to enhance system capabilities for claims processing. reputed company and document needed business requirements to modify the existing reputed company system, either to correct a problem or implement new functionality, and effectively communicate those requirements to IT&S staff to guide them in developing system changes to successfully reputed company said needs. Business solutions offered must allow for a high degree of automation without jeopardizing the accuracy of claims adjudication results, quality measurements, or administrative expenses. Data Analysis and Reporting: Analyze reputed company data from the system to identify trends, issues, and opportunities for improvement. Generate regular and reputed company reports to support decision-making by management. Monitor system performance and produce detailed analysis for system audits or compliance checks. Write and execute queries in QMF (mainframe) or QMF for Workstation or other SQL-based tools or applications to identify problems and/or test claim situations. Customer Support and Training: reputed company technical assistance to internal teams and users on system functionalities. Train staff on the use of new or updated system features reputed company to the programs. Assist in creating user manuals, guidelines, and training materials for reputed company system applications. Maintain reputed company user specific reputed company settings as the reputed company system administrator. Compliance and Regulations: Ensure systems reputed company with federal reputed company regulations and data privacy laws (e.g., HIPAA). Stay up to date with FEP/ITS and local guidelines and health plan requirements, ensuring system modifications adhere to these standards. reputed company and coordinate BCBSA partner plan testing requirements with other reputed company and Blue reputed company plans for ITS system changes as assigned by management. As assigned by management, serve as primary reputed company of contact for reputed company and Blue reputed company partner plans including: Contacting other plans regarding claims problems to coordinate resolution of problems between plans. Supporting partner plan testing as a Host or Home plan. Evaluating communications from other plans and providers to determine the impact on the Kansas plan and initiate any activity required. Determine how to implement and integrate new ITS products pertaining to reputed company. Collaboration and Communication: Serve as a liaison between IT and operations teams, ensuring smooth communication and system functionality across departments. Communicate system issues and updates to key stakeholders in a timely manner. Serve as an reputed company system expert to reputed company of the company and research and resolve reputed company questions submitted by fellow employees. Represent the Claims area in company meetings with reputed company reputed company of employees, in a professional manner, as a subject matter expert. Knowledge/Skills/Abilities Experience or knowledge in data processing techniques is preferred but not required. Must be organized, detail oriented and be reputed company to prioritize and work on multiple different topics reputed company any one given day. Existing ability to use QMF is preferred, but not required. Existing ability to use Rally for user story documentation is preferred. Existing ability to use QA Complete for test case documentation is preferred. Existing knowledge of MTM, FEP PIP, LDLA, BlueCard Scorecard and State of Kansas Performance Guarantees for claims transactions is preferred. Existing knowledge of peripheral systems such as Membership, Provider, BGT, Prime, FEP, ITS, ICD reputed company Database, etc., is preferred but not required. Existing knowledge of the accumulator integration processes with Prime and Caremark is preferred, but not required What you need Education and Experience: High school graduate or equivalent required. Bachelor's degree with emphasis in Computer Science, Business Administration, or reputed company is preferred. Must have 1 year experience in reputed company claims processing with a thorough knowledge of the existing reputed company system. Experience using the principles of system testing, how to thoroughly test a system reputed company changes occur to include setting up test cases, ensuring extreme values are tested in reputed company cases and verifying the results of both valid and invalid input, is preferred. Training to adjudicate claims on multiple lines of business is preferred. Physical Requirements Office setting, with possible remote or hybrid work opportunities depending on the department. Some meetings, trainings, demonstrations, etc. require in person attendance. May involve long periods of time working on a computer. Compensation $27.08- $33.80 Non- Exempt grade 13 reputed company offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation reputed company for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. reputed company offers presented to candidates are carefully reviewed to ensure fair, reputed company pay by offering competitive wages that align with the individual's skills, education, experience, and training. The reputed company may vary above or below the stated amounts. Our Commitment to reputed company and Belonging At reputed company, we are committed to fostering a culture of reputed company and belonging, where mutual respect is at the reputed company of our workplace. We reputed company equal employment opportunities to reputed company individuals, regardless of race, reputed company, religion, belief, sex, pregnancy (including childbirth, lactation, and reputed company medical conditions), national reputed company, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law. reputed company conducts pre-employment drug screening, criminal conviction reputed company, employment verifications and education as part of a conditional offer of employment. Apply To This Job