Claims Examiner

Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.

You Belong At Blue

Why Join Us?

• Make 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 all employees. 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

• Base compensation is only one component of your competitive Total Rewards package
  • Incentive pay program (EPIP)
  • Health/Vision/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
  • Health & fitness benefits, discounts and resources

Job Summary

A health claims examiner is responsible for reviewing, evaluating, and processing health, drug, dental and/or ancillary product claims submitted by members or providers for insurance reimbursement. The job involves ensuring that claims are processed accurately and timely, in accordance with policy terms, industry regulations, and company guidelines.

This position is scheduled to start December 7, 2026.

Work Location:

This position will work remotely in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.

What you'll do

• Accurately review, analyze, and verify healthcare claims submitted by policyholders or medical providers.
• Ensure all necessary documentation, coding (International Classification of Diseases, Tenth Revision (ICD-10), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS)), and data are included and correct.
• Check for eligibility, coverage, and applicable benefits as per policy terms.
• Enter and process claims information into the system with precision and attention to detail.
• Apply appropriate insurance guidelines, including deductibles, co-pays, co-insurance, and maximum coverage limits.
• Approve or deny claims based on policy coverage, ensuring compliance with regulatory and company standards.
• Perform adjustments to processed claims as needed for corrective action.
• Correspond with healthcare providers, patients, and internal departments to clarify or resolve discrepancies.
• Investigate and resolve complex or escalated claim issues, such as coding errors, benefit misunderstandings, or billing discrepancies.
• Ensure compliance with state and federal healthcare regulations.
• Supports core values, policies, and procedures
• Maintain detailed and accurate records of all claims processed, including documentation for audits or reviews.
• Meet individual and team performance targets related to claims processing speed, accuracy, and quality.
• Participate in ongoing training to stay updated on changes in health insurance policies and claims processing technologies.
• Monitor and work daily reports to ensure timely claim control.
• Performs other duties that may be assigned from time to time

What you'll need


Education

• High school diploma or equivalent required

Experience

• Previous experience in healthcare claims processing, medical billing, medical terminology, or health insurance preferred

Knowledge, Skills and Abilities

• Strong attention to detail and organizational skills.
• Knowledge of medical claim processing, medical terminology, insurance policies, and coding standards (ICD, CPT).
• Excellent communication skills, both written and verbal.
• Ability to work efficiently under pressure and meet deadlines.
• Critical thinking and problem solving skills
• Office and/or computer system experience preferred

Compensation

$20.96 - $26.20
*Non-exempt, Grade 11*

• Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.

Our Commitment to Connection and Belonging

At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, 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.

Blue Cross and Blue Shield of Kansas conducts pre-employment drug screening, criminal conviction check, employment verifications and education as part of a conditional offer of employment.