Mar 21, 2026
CareFirst BlueCross BlueShield
Resp & Qualifications PURPOSE: Investigate and perform adjustment of highly complex claims and ensure that claims are handled properly within authority limits, and in line with standard procedures and guidelines. Verifies Insurance Claims by reviewing claims requirements; examining documentation and calculations; highlighting and summarizing out-of-line situations; recommending changes in operating processes; completing reports, logs, and audit records. Perform as a team leader to lower-level Claims adjusters. ESSENTIAL FUNCTIONS: Proactively investigate and perform highly complex adjustment of claims. Ensure claims are handled within authority limits, and in line with standard procedures and guidelines. Serve as the primary resource for assisting the Supervisor with training new adjusters and developing Adjusters Is and IIs. Identify problems or trends related to adjustments performed. Initiate problem reports for corrective...
Professional Diversity Network
Columbia, MD, USA
Full-Time
