Blue Shield of California strives to create a healthcare system worthy of its family and friends that is sustainably affordable. 

Blue Shield of California is a tax-paying, nonprofit, independent member of the Blue Shield Association with 4.7 million members, 7,800 employees, and $22.9 billion in annual revenue. 

Founded in 1939 in San Francisco and now headquartered in Oakland, Blue Shield of California and its affiliates provide health, dental, vision, Medicaid and Medicare healthcare service plans in California. 

Blue Shield of California complies with applicable state laws and federal civil rights laws, and does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, or disability.

Blue Shield of California cumple con las leyes estatales y las leyes federales de derechos civiles vigentes, y no discrimina por motivos de raza, color, país de origen, ascendencia, religión, sexo, estado civil, género, identidad de género, orientación sexual, edad ni discapacidad.

Blue Shield of California 遵循適用的州法律和聯邦公民權利法律，並且不以種族、膚色、原國籍、血統、宗教、性別、婚姻
狀況、性別認同、性取向、年齡或殘障為由而進行歧視。

Industry: Insurance
Company Size: 5,001-10,000 employees

Blue Shield of California

Savvy Admin PROD

**Job Description**

**Your Role**

The Medi-Cal Operations team is responsible for ensuring claims are processed accurately and timely. The Claims Processor, Specialist will report to the Medi-Cal Operations Supervisor. In this role you will be responsible for interfacing with other departments and vendors involved in the Claims process and will also serve as the primary point of contact for priority claim cases.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

**Responsibilities**

**Your Work**

In this role, you will:

- Handle most complex activities including backup for all areas of claims processing

- Actively participate in projects

- Handle escalated issues independently

- Mentor experienced team members

- Assist with training when needed

- Collaborate with peers, staff in other department's vendors, and Management to improve processes and department work quality.

- Must be able to work in a fast-paced environment with minimal supervision

- Read and interpret documents such as provider contracts procedure manuals, various reports, division of financial responsibility matrix

**Qualifications**

**Your Knowledge and Experience**

- Requires a high school diploma or GED

- Requires at least 7 years of experience

- Minimum of 3 years of experience in claims processing and/or auditing experience in a manage care setting required

- Experience examining multiple claim types in the Medi-Cal/Medicare environment preferred

- Knowledge of medical claims regulatory guidelines such as AB1455 and Medicare preferred

- Proficiency in Microsoft Office programs such as Excel, Word and Outlook required

**Hybrid Virtual Work**

This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.

**About The Team**

**About Blue Shield of California**

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!

**Our Values:**

- Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.

- Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.

- Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

**Our Workplace Model**

We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:

- For most teams, this means coming into the office two days per week.

- Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.

- For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.

**Physical Requirements:**

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Please click here for further physical requirement detail.

**Equal Employment Opportunity:**

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

Claims Processor, Specialist

CareFirst. It’s not just our name. It’s our promise. Over 3.5 million people trust us with their healthcare needs, and we take this responsibility seriously.  

Our vision for healthcare is clear. Quality care should be easy to afford, easy to use and available to everyone. And what we’re building for you is exactly what we expect for ourselves and those we love.  

Every day, we make a meaningful difference in the communities where we live and work. We solve real problems for the people we serve with equal parts empathy and urgency—simplifying the complex, delivering tailored solutions and stepping forward with new ideas. 

RECRUITMENT FRAUD NOTICE: CareFirst is aware of an increase in fraudulent job offers being made on behalf of our recruitment team. Legitimate CareFirst recruiters will always contact you from an email address ending in “@carefirst.com” and will never ask for a payment in exchange for a job opportunity or ask you to submit sensitive personal information via email, phone, or text.  

Independent licensee of BCBSA.

Industry: Insurance
Company Size: 5,001-10,000 employees

CareFirst BlueCross BlueShield

**Resp & Qualifications**

**PURPOSE:**

Under direct supervision, reviews and adjudicates paper/electronic claims. Determines proper handling and adjudication of claims following organizational policies and procedures.

**Essential Functions**

- Examines and resolves non-adjudicated claims to identify key elements of processing requirements based on contracts, policies and procedures. Process product or system-specific claims to ensure timely payments are generated and calculate deductibles and maximums as well as research and resolve pending claims. The Claims Processor also use automated system processes to send pending claims to ensure accurate completion according to medical policy, contracts, policies and procedures allowing timely considerations to be generated using multiple systems.

- Completes research of procedures. Applies training materials, correspondence and medical policies to ensure claims are processed accurately. Partners with Quality team for clarity on procedures and/or difficult claims and receives coaching from leadership. Required participation in ongoing developmental training to performing daily functions.

- Completes productivity daily data that is used by leadership to compile performance statistics. Reports are used by management to plan for scheduling, quality improvement initiatives, workflow design and financial planning, etc.

- Collaborates with multiple departments providing feedback and resolving issues and answering basic processing questions.

**Qualifications**

**Education Level: **High School Diploma or GED.

**Experience: **Less than one year experience processing claim documents.

**Preferred Qualifications**

- Less than one year claims processing, billing, or medical terminology experience.

**Knowledge, Skills And Abilities (KSAs)**

- Demonstrated analytical skills.

- Demonstrated reading comprehension and ability to follow directions provided.

- Basic written/oral communication skills.

- Demonstrated ability to navigate computer applications.

- Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

**Salary Range: **$31,968 - $58,608

**Salary Range Disclaimer**

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

**Department**

Large Group Claims Operations

**Equal Employment Opportunity**

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

**Where To Apply**

Please visit our website to apply: www.carefirst.com/careers

**Federal Disc/Physical Demand**

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

**Physical Demands**

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

**Sponsorship in US**

Must be eligible to work in the U.S. without Sponsorship

Claims Processor I (Remote)

Founded in 2008, Indianapolis-based Northwind Health Company provides comprehensive employer-funded health solutions including third-party administration, pharmacy benefit management, pharmacy services as well as chronic disease management. Northwind is an industry pioneer known for dramatically reducing wasteful spending and producing member health to improve their client’s bottom line.

Industry: Hospitals and Health Care
Company Size: 51-200 employees

Northwind Health Company

**Company Description **

Founded in 2008 and based in Indianapolis, Northwind Health Company provides comprehensive employer-funded health solutions, including third-party administration, pharmacy benefit management, pharmacy services, and chronic disease management. Northwind is recognized as an industry pioneer, known for driving significant cost savings and improving health outcomes for its clients. The company's innovative approach is focused on minimizing wasteful spending and optimizing member health, ensuring value for organizations and their employees.

**Role Description **

This is a full-time on-site role located in Indianapolis, IN, for a Senior Claims Processor. Responsibilities include accurately reviewing, processing, and adjudicating insurance claims while ensuring compliance with company policies and regulatory standards. The Senior Claims Processor will validate claim information, resolve discrepancies, maintain up-to-date records, and provide exceptional customer service by addressing inquiries and resolving claim-related issues. Collaborating with internal teams to streamline processes and ensure efficiency is also a critical part of this role.

**Qualifications **

- Proficiency in claims processing, documentation, and analysis

- Strong attention to detail, accuracy, and ability to work independently

- Knowledge of regulatory compliance related to healthcare or insurance claims

- Excellent communication and customer service skills

- Familiarity with claims management systems and software

- Problem-solving skills and ability to resolve complex claim discrepancies

- Previous experience in a similar role and/or healthcare-related field preferred

- Bachelor’s degree in Business Administration, Health Management, or a related field is an advantage

Senior Claims Processor

Our mission is clear: to become a lifelong mobility partner for our customers and communities by creating meaningful progress through clean energy, connected technology, and human-centered innovation.

Hyundai Motor Company is a global mobility leader committed to shaping a better future. With more than 120,000 employees across 200+ countries, we are redefining the way the world moves, not just through innovation in automotive design, but through bold investments in smart mobility, sustainability, and technology.

Each year, we bring over 4.6 million vehicles to drivers around the globe – from award-winning sedans to cutting-edge electric and hydrogen-powered solutions.

Industry: 자동차 제조
Company Size: 직원 10,001명 이상

Hyundai Motor Company

**Company Description**

Hyundai Motor Company, founded in 1967, is a global leader in mobility solutions, operating in over 200 countries with a workforce of more than 120,000 employees. Guided by the vision of "Progress for Humanity," Hyundai focuses on addressing real-world mobility challenges through innovative solutions, including next-generation electric vehicles, robotics, and hydrogen-powered advancements. With a commitment to human-centered innovation, we continuously strive to drive positive change and shape the future of mobility. Join us in creating groundbreaking solutions to improve the way the world moves.

**Role Description**

This contract role for an Incentive Claims Processor is based on-site in Fountain Valley, CA. The position involves reviewing and processing incentive claims in accordance with company policies and procedures. The Incentive Claims Processor will ensure accuracy and compliance in claim submissions, liaise with internal teams and stakeholders, provide support to claimants, and generate regular reports on claim trends and outcomes. Strong organizational skills and attention to detail are essential in this role.

**Qualifications**

- Proficiency in Claims Processing and understanding of Claims Management principles

- Basic knowledge or experience in Insurance concepts and processes

- Strong Communication and Customer Service skills to interact effectively with stakeholders

- Excellent organizational skills, attention to detail, and ability to manage deadlines

- Proficiency in using claims management systems and office software

- Relevant experience or a background in customer support roles is advantageous

- Bachelor's degree in a relevant field is a plus but not required

Incentive Claims Processor

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