Detailed description of the position:
A candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, as well as internal pay equity and external market-driven rates, all have an impact on base pay. The displayed salary range has not been adjusted for location. Based on information Capital Blue Cross had at the time of posting, this range was created in good faith and may change in the future. Capital Blue Cross provides a comprehensive package of benefits, including coverage for medical, dental, and vision expenses, a retirement plan, generous paid time off, holidays, and volunteer time, an incentive plan, tuition reimbursement, and other benefits.

We promise to go above and beyond for our team and the community at Capital Blue Cross. Our employees consistently rate us as one of the “Best Places to Work in Pennsylvania” due to the centrality of this promise in our culture. The preparation of ASO (Administrative Services Only) and CDH group invoices and letters that include medical and vendor claims, additional administrative costs, and other fees is the responsibility of this position.

The incumbent is in charge of keeping track of payments and creating reports on special request ASO group invoicing.

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As requested by Account Administration Operations, Marketing, Underwriting and Rating, and Finance/Accounting personnel, the incumbent investigates and resolves rate, payment, and claim discrepancies.

researches requests to move claim utilization from one group to another and serves as a liaison between the department’s various units to coordinate the resolution of group-related issues. accountable for reviewing the in-depth data that makes up the majority of an ASO group’s invoice. In charge of completing invoices and compiling supporting documentation in accordance with the SSAE16 and MAR audit process control requirements. ensures that each component of the billing is billed and documented.

Qualifications and responsibilities:

Experience:

demonstrates proficiency in using a computer and a variety of software programs, such as Facets, Microsoft Word, Excel, and Access, and the capacity to create standard and individualized reports.
demonstrates professional and effective communication skills over the phone, via voice mail, via electronic mail, in person, and in writing.

Skills:

familiar with all financial aspects of ASO accounts, including vendors, stop-loss, advances, letters of credit, and rating types. the CBC.

demonstrates proficiency in arithmetic, percentage, and statistical calculations. Excellent organizational skills, as well as the capacity to schedule one’s own work and adjust to shifting priorities in order to meet deadlines in a time crunch.

Participates in assigned special projects.

aptitude for working both independently and as part of a team.

ability to examine a variety of billing and financial reports.

Knowledge:

ability to use the ASO system to request claim data, create personal computer-based invoices and letters, monitor payments using Accounting and Account Administration, etc.
ability to apply and explain ASO account adjustments and knowledge of ASO adjustments.
knowing how to renew rates so that rates can be checked and differences between rates can be fixed.
familiar with the procedures for changing the benefits of existing groups and forming new groups.
The ability to accurately research group reporting requires knowledge of the Facets, ASO Vendors, and the group account reporting procedures.
Needs for the Body: The employee is frequently required to sit, use their hands and fingers, talk, hear, and see while carrying out the job’s responsibilities. The worker must be able to put in more than 40 hours a week. The worker is occasionally required to lift and/or move up to five pounds.

What We Do: We encourage a flexible work environment where your health and well-being are prioritized because we understand that work is an integral part of life. You will be encouraged to volunteer in your community and will work with a diverse and caring team of colleagues who are there to support you. We put a lot of money into training and continuing education because we care about your personal and professional development. This gives you the tools you need to do your best as your career grows. In addition, if you put in your best effort, you will help us fulfill our mission of enhancing our members’ health and well-being and the communities in which they live.

blue cross blue shield work from home

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blue cross blue shield work from home

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Other Jobs You May Be Interested In

blue cross blue shield work from home

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