Claims Specialist
Blue Cross NC · Remote Flex (NC)
- Remote Flex - North Carolina; full-time on the Claims Operations Team at Blue Cross NC.
- Review and timely adjudicate claims in accordance with contractual benefits and health care policies.
- Manage daily work queues and monitor claim turnaround times to meet compliance and performance guarantees.
- Respond promptly and accurately to inquiries from Customer Service Professionals, subscribers, providers, and other carriers.
- Determine suspended claim resolution methods by reviewing benefit eligibility and claims history.
- Review claims for possible fraud and abuse and refer to the Special Investigations Unit.
- Applications close September 30, 2026.
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