OPL Claims Correspondent

Investigate claims involving duplicate coverage, blue on blue, auto no-fault, and workers' compensation. Initiate adjustments when necessary. Daily activity deals with all Blue Cross and Blue Shield contracts/lines of business and performing OPL calculations. "This position is eligible to work onsite or hybrid (9 or more days a month onsite), or remote in accordance with our Telecommuting Policy. Applicants must reside in Kansas, Missouri or be willing to relocate to another approved state as a condition of employment." Why Join Us? • Family Comes First: Total rewards package that promotes the idea of family first for all employees; including paid time off and family first leave. • Professional Growth Opportunities: Advance your career with ongoing training and development programs both through our internal Blue University and external opportunities. • Dynamic Work Environment: Collaborate with a team of passionate and driven individuals. • Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans. • Stability: 80 years of commitment, compassion, and community • Networking Opportunities: Participate in our corporate intern program and network with other interns at BCBSKS to enhance your learning opportunity. Compensation $20.96- $26.20 Non- Exempt 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. Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas. What you'll do Responsibilities: Investigate claims received within the department to make accurate determination of Blue Cross and Blue Shield of Kansas payment liability (Other Party Liability). Properly load notes/trailers and research claims based on information received from insureds/providers. Recognize and refer policy and technical problems for management/supervisory action or Help Desk assistance. Provide input and assistance for system improvements. Perform online claim maintenance activity to records which result in system "kick-outs" of claims needing OPL involvement or to allow the accurate payment of claims. Analyze inquiry to determine course of action necessary and order/review related research materials when necessary. Initiate phone calls to providers, other insurance carriers, and groups, to obtain information or clarify circumstances. Remain current on state law, corporate contract and policy, and NAIC guidelines relative to application of contract benefits for auto no-fault, workers' compensation, duplicate coverage and subrogation. Must comply with and implement corporate information security policies, standards, and guidelines relative to access control. Perform Job related special projects as assigned What you need Knowledge/Skills/Abilities • College or training courses in medical terminology is preferred • Twelve months of claims experience is preferred • Knowledge of Worker Compensation and Kansas Auto No- fault laws are preferred • Verbal, written and human relation skills • Knowledge of IC10 Coding is preferred • Communication skills • Ability to work independently and part of a team Education and Experience: • High school graduate or equivalent is required • One year claims experience or One-year BCBSKS Customer Service Representative Experience required. • Knowledge of Worker Compensation and Kansas Auto No-fault laws are preferred • College or training course in medical terminology preferred • Knowledge of IC10 is preferred • Human relation skills Physical Requirements • Computer work is required at least 95% of workday. Benefits & Perks • Base pay 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 • 5% 401(k) plan matching • Tuition reimbursement • Health & fitness benefits, discounts and resources 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. Apply tot his job Apply To this Job