Please email HR_Talent_AcquisitionTeam@bcbsri.org if you are a candidate seeking a reasonable accommodation for the application and/or interview process.
Schedule: Hybrid or Remote
Compensation: $24 -$26/hr.
Jump into the new world of health insurance: At Blue Cross & Blue Shield of Rhode Island (BCBSRI), our business is healthcare. But our focus is on improving lives. Be part of a team that is large enough to make a difference but small enough to be innovative. Work in a rapidly changing field. Take a chance to be creative. Move outside the status quo. Shape new ideas with the power of a national brand behind you.
Join others who know diversity is strength: We appreciate and celebrate everything that makes us unique: age, national origin, citizenship status, perspectives, experiences, physical or mental disability, military status, race, ethnicity, religion, gender, sexual orientation, gender identity and/or expression. Our diversity strengthens us as an organization and helps us better serve an increasingly diverse Rhode Island population.
Why this job matters: Facilitate the administration and resolution of workers compensation cases. Ensure compliance with state and federal guidelines along with internal protocols. Maintain all treatment plan documentation. Provide administrative and project support to the department and/or management.
What you will do:
- Respond to internal and external inquiries; assist with the implementation of appropriate treatment plans for injured workers/member cases. Ensure adherence of internal and external protocols on all cases.
- Activate new workers compensation member cases; review questionable provider treatment recommendations with clinical staff. Document case findings, update treatment plans, and monitor open cases. Consult with workers compensation vendor regarding billing issues, reactivated cases, etc.
- Review claims history to ensure appropriate release and payment of medical bills pertaining to the injured worker.
- Provide accurate data entry in medical information systems and other applicable databases. Update and track treatment plans, ensure plans are aligned with internal protocol.
- Research claims and coverage data; verify eligibility for payment purposes.
- Review billing reports; ensure accuracy and appropriateness of payments.
- Arrange for second opinions as requested, schedule appointments and send medical and/or dental records.
- Participate in department initiatives and projects.
- Perform other duties as assigned.
What you need to succeed:
- High school degree or an equivalent combination of education and experience
- Two to four years' experience in a managed care environment
- Knowledge of health insurance laws and regulations
- Knowledge of medical terminology
- Working knowledge of Microsoft Office including Excel, and Word
- General computer proficiency
- Written and verbal communications skills
- Good organization skills
- Time management skills
- Detail oriented
- Ability to research and organize data
- Ability to organize work efficiently to meet established time and quality standards
The extras:
- Proficiency with Microsoft Suite of products; i.e., Word, Excel, PPT, etc
- Prior health insurance industry experience (Customer service, Claims, Systems)
- Knowledge of Salesforce and Facets
Location: BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role:
- In-office: onsite 5 days per week
- Hybrid: onsite 2-4 days per week
- Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia
At Blue Cross & Blue Shield of Rhode Island (BCBSRI), diversity and inclusion are central to our core values and strengthen our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity, affirmative action employer. We provide equal opportunities without regard to race, color, religion, gender, age, national origin, disability, veteran status, sexual orientation, genetic information and gender identity or expression.
The law requires an employer to post notices describing the Federal laws prohibiting job discrimination based on race, color, sex, national origin, religion, age, equal pay, disability, veteran status, sexual orientation, and genetic information and gender identity or expression. Please visit https://www.eeoc.gov/employers/eeo-law-poster to view the "EEO is the Law" poster.
