The primary function of the Claims Research Associate position is twoandfold, consisting of medical claims processing and inquiry resolution Each claim is processed according to business regulation, internal standards, and processing guidelines Inquiries are resolved within accuracy and timeliness goals, specific to customer contract agreements. The Incumbent is responsible for reviewing claims for errors and comparing member benefits to services requested. The Incumbent will also perform an analysis of the claim and make necessary updates that may include recalculation of benefits for previously processed claims to determine the correct order of benefits for payment to be made by the applicable plan It is also the responsibility of the incumbent to reject, redirect misrouted, or ask clarifying questions when information is incomplete or inaccurate to ensure timely processing as outlined by service level agreement goals. The Incumbent will be responsible for communicating via inquiry, email and telecommunication across multiple areas of the company to ensure customer resolution is complete. The Inquiry and Claims Management Solutions (ICMS) program is designed to provide a structured and engaging environment to learn all functions of the Claims Research Associate position of Blue Cross and Blue Shield of Alabama. The program is structured into five phases: training (Phases 1and3), benchmark(Phases 2and4), and Fluency The maximum duration of the program for each incumbent for phase one (classroom training) is up to 13 weeks depending on the training program; while phase two can last as long as 18 weeks (benchmark/practical application) For an associate to reach phase three training (fluency), the incumbent must meet production, timeliness and quality goals that are in place under phase two The fluency phase will last 13 weeks After successfully completing the three training phases, the associate is then transitioned into the Inquiry Analysis and Claims Solutions (IACS) area within the Claims division. Phases One and Three: Classroom Training Phases and The training program consists of computer-based course work, facilitator-led discussion and practical application. The associate must apply the training concepts appropriately and achieve an expected standard of performance during the training program. The training goals for practical application are established to assist associates in reaching the minimum established performance level of accuracy, timeliness, and production for this position. Phases Two and Four: Benchmark Phases and Incumbent will work toward achieving actual production, quality, and timeliness goals that are currently in place in the Claims division Associates are aggressively paced through this program by being placed on and mini-goals and each week They currently have a maximum time of 18 weeks to achieve the actual goal of the position. Phase Five: Fluency Phase and Incumbent has successfully and bench marked and and is placed into the department's fluency phase in Claims.

　　QUALIFICATIONS:High School Diploma or equivalent. Experience interacting with customers. Experience in a position requiring problem-solving and analytical skills. Experience in a position demonstrating time management and organizational skills to organize and prioritize tasks. Experience in a position demonstrating research skills to research information using a computer and/or reference materials. Demonstrated experience in a keying environment. Strong communication skills to interpret and communicate information both orally and written, including documenting detailed information. Bachelor's Degree preferred. Experience in a position with production, accuracy, and/or timeliness requirements preferred. Experience adjusting and adapting to necessary changes due to business needs preferred / Claims coding and ICD knowledge preferred.

　　Start date will take place in April of 2024