Claims Systems Specialist at Blue Cross and Blue Shield of Kansas

This job was posted by https://www.kansasworks.com : For more

information, please see: https://www.kansasworks.com/jobs/13606776 Are

you ready to make a difference? Choose to work for one of the most

trusted companies in Kansas.

You Belong At Blue

• Why Join Us?
• Make a Positive Impact: Your work will directly contribute to

the health and well-being of Kansans.

• Family Comes First : Total rewards package that promotes the

idea of family first for all employees. Paid vacation and sick leave

with paid maternity and paternity available immediately upon hire

• Professional Growth Opportunities: Advance your career with

ongoing training and development programs.

• Dynamic Work Environment: Collaborate with a team of passionate

and driven individuals in a work environment that promotes

flexibility.

• Trust and Stability: Work for one of the most trusted companies

in Kansas with over 80 years of commitment, compassion and

community.

• Inclusive Work Environment: We pride ourselves on fostering a

workplace where everyone is valued and respected.

Benefits & Perks

• Base compensation is only one component of your competitive Total

• Incentive pay program (EPIP)
• Health/Vision/Dental insurance
• 6 weeks paid parental leave for new mothers and fathers
• Fertility/Adoption assistance
• 2 weeks paid caregiver leave
• 401(k) plan matching up to 5%
• Tuition reimbursement
• Health & fitness benefits, discounts and resources

Claim Entry System (ACES) as reported by ACES users and document

problems in SBM. Develop, document, test, and approve system

modifications, in tandem with Information Technology & Services (IT&S)

staff, in ACES needed to resolve problems or develop new functionality.

Maintain system security within ACES. Act as a liaison between IT&S and

ACES users.

This position is eligible to work remotely, hybrid, or onsite in

accordance with our Telecommuting Policy. Applicants must reside in

Kansas or Missouri or be willing to relocate as a condition of

employment.

What you'll do

Responsibilities

System Management and Support

• Maintain, update, and troubleshoot healthcare systems related to the

claims programs and peripheral systems such as membership, BGT,

Provider, etc.

• Ensure data integrity and accuracy in claims processing and

eligibility systems.

• Coordinate with IT and operational teams to resolve system issues

and ensure seamless functionality.

• Participate in system upgrade projects, implementing new

functionalities and enhancements to support BCBSKS operations.

• Work with cross-functional teams, including developers, analysts,

and business leaders, to ensure project deliverables are met.

• Assist in the development of project plans, timelines, and

documentation for system improvements.

• Collaborate with claims and eligibility teams to identify system

needs and ensure efficient processing of claims.

• Conduct testing and validation of system changes to ensure they

align with guidelines and standards.

• Develop and update workflows to enhance system capabilities for

claims processing.

• Develop and document needed business requirements to modify the

existing ACES system, either to correct a problem or implement new

functionality, and effectively communicate those requirements to

IT&S staff to guide them in developing system changes to

successfully achieve said needs. Business solutions offered must

allow for a high degree of automation without jeopardizing the

accuracy of claims adjudication results, uality measurements, or

administrative expenses.

• Analyze healthcare data from the system to identify trends, issues,

and opportunities for improvement.

• Generate regular and ad-hoc reports to support decision-making by

management.

• Monitor system performance and produce detailed analysis for system

audits or compliance checks.

• Write and execute queries in QMF (mainframe) or QMF for Workstation

or other SQL-based tools or applications to identify problems and/or

test claim situations.

• Provide technical assistance to internal teams and users on system

functionalities.

• Train staff on the use of new or updated system features related to

the programs.

• Assist in creating user manuals, guidelines, and training materials

for healthcare system applications.

• Maintain ACES user specific security settings as the ACES system

administrator.

• Compliance and Regulations**:

Ensure systems comply with federal healthcare regulations and data

privacy laws (e.g., HIPAA).

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