Provider Data Specialist

Claims Benefit Administration (CBA) area supports the analysis, design and implementation of group benefits, the creation of Summary Plan Descriptions, the development of Blue Exchange records, the creation of Benefits Online and day-to-day involvement in the development and implementation of strategies designed to address complex processing issues through project implementation. CBA also is involved in process improvements and maintenance on behalf of the Claims Division which support our Divisional, Corporate, and Mandated initiatives. Our highly technical projects support the enhancement of critical benefit application, system corrections, mandated changes and corporate initiatives which affect global areas of Claims Processing.

The Claims Provider Data Specialist is responsible for providing extensive research, development and validation of provider information received through claims suspense Work Distribution Management System (WDMS), Work Distribution Management System Inquiry (WDMSI) correspondence, Pega images, faxes, emails, and other forms of communication. The incumbent provides accurate and timely use of resources which include, but is not limited to; professional and courteous telephone, fax, and email communications with providers and interoffice personnel. Extensive research of internal databases and Internet sources is required. The associate is responsible for accurately enrolling and maintaining provider records that are used in processing claims and Internal Revenue Service (IRS) compliance. Accurate and timely development of provider data is essential for meeting national standards, administration of benefits in claims processing, and correct IRS Tax Reporting compliance to avoid backup withholdings and costly IRS penalties and audits. This position is also responsible for maintaining the privacy and confidentiality of the provider and subscriber information gathered through research and validation methods.

• High school diploma or equivalent
• Experience in a position utilizing Windows applications
• Experience in claims, customer service or other related member or provider support role
• Excellent written and oral communication skills
• Experience with WDMS / WDMSI and Pega systems preferred
• Knowledge of Blue Cross and/or Blue Shield and Major Medical claims processing and/or benefits preferred
• Experience in a health care environment preferred
  

The work location for this position will be full-time remote.

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Blue Cross and Blue Shield of Alabama is an independent licensee of the Blue Cross and Blue Shield Association