Claims Examiner II

At Blue Cross and Blue Shield of Nebraska , we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve. Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there’s no greater time for forward-thinking professionals like you to join us in delivering on it! As a member of Team Blue, you’ll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community. Adjudication of healthcare claims utilizing employer and payer specific policies and procedures. Responsible for reviewing the data in the claims processing system and compare with corresponding CMS and billing guidelines. Responsible for reviewing medical claims attachments when necessary to determine if services rendered was medically appropriate and benefit coverage criteria has been met. Responsible for reviewing adjudication software system’s claim and line item edits for determination of whether to pay claim/line item(s). May forward claims to specialized internal and external resources. Corresponds with other departments as necessary to process claims. Accountable to performance metric scorecards. Provide guidance to less experienced claims examiners. Candidates applying to this remote position are required to live in the state of Nebraska or local Omaha metro area. What you'll do: Respons