Overview
Claims Specialist Jobs in Topeka, KS at Blue Cross and Blue Shield of Kansas
Title: Claims Specialist
Company: Blue Cross and Blue Shield of Kansas
Location: Topeka, KS
This job was posted by https://www.kansasworks.com : For more
information, please see: https://www.kansasworks.com/jobs/13610127 **Are
you ready to make a difference? Choose to work for one of the most
trusted companies in Kansas.**
- 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
Rewards package
- 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
**Job Summary**
The AICK Claims Specialist will administer, review, and approve or deny
all types of claims, for the products marketed by AICK, to include
Waiver of Premium, Term Life, Accidental Death & Dismemberment, Short
Term Disability, Long Term Disability, Living Benefit Rider, Ordinary
Life, Yearly Renewable Term, all Voluntary Life and Accidental Death &
Dismemberment coverage. This position also plays a part in helping
develop new products, answering questions regarding how the provisions
of a policy are administered and serving on Ad Hoc teams representing
AICK as needed.
"This position is eligible to work 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**
- Review, investigate, and adjudicate all claims (approval or denial)
by verifying eligibility, coverage, and contract provisions,
including obtaining additional information from employers,
hospitals, reinsurers, and other external partners.
- Ensure claim handling complies with all regulatory requirements,
including ERISA, NAIC unfair claims practices, and applicable state
regulations, and that claims are processed within statutory
timeframes with appropriate documentation.
- Interpret and apply policy provisions, reinsurance treaties, and
group contracts to determine claim payability, reinsurer liability,
and continuation of liability; partner with reinsurers to confirm
determinations.
- Conduct in-depth investigations on complex or questionable claims,
including coordinating with investigators or rehabilitation
specialists and preparing documentation for potential legal
proceedings when required.
- Manage disability claims lifecycle, including review and processing
of continuance requests, evaluation of treatment plans, and
assessment of rehabilitation or return-to-work options.
- Communicate claim decisions and policy provisions clearly to
claimants, employers, attorneys, and regulatory bodies via phone and
written correspondence, including responses to denials and
inquiries.
- Manage overpayment recoveries and collections, including
establishing and monitoring repayment arrangements with claimants.
- Maintain accuracy of claim account and systems by verifying
reports, reconciling balances, making necessary adjustments, and
approving claims for payment per guidelines.
- Research and respond to State Insurance Department complaints,
implement corrective actions as needed, and maintain required
complaint logs in compliance with regulatory standards.
- Support contract updates and product development initiatives by
collaborating across departments, participating in Ad Hoc teams, and
identifying operational or compliance improvement opportunities.
- Compile and report required financial and operational data,
including Schedule F for the Annual Statement, management reports
(e.g., claim processing time, paid claims, closed claims), and other
required reporting (FICA, W-2/W-3).
- Participate in system testing for claims payment platforms,
including validation of new releases and defect fixes.
**What you need**
**Knowledge/Skills/Abilities**
Ability to analyze detailed contract provisions and make decisions based
on a set of facts or criteria.
Excellent written and verbal communication skills.
Extensi