Operations Processor

Transformation is the opportunity. To change the future of health care in California, Blue Shield needs people who believe in the possibilities and are willing to work to make them real. Is this you?

This position processes health plan related data and information using automated systems within established production and quality standards.

Makes decisions based on review of source documents for routine and difficult processing issues.

Looks up correct codes and enters data into system.

Researches information as appropriate to resolve problem encounters or claims not accepted by systems edits.

Contacts other internal staff to verify information and contacts physicians, and IPA providers for additional information as needed to complete processing work.

Prepares necessary case documents for further medical review.

Works under minimal supervision and responsible for assignments that range from routine to moderately complex.

Makes recommendations to management for improvements in work processes.

Requires keystroke testing of 7000ksph or 35 wpm with 5% error rate or less with numbers and letters.



Blue Shield of California is an Equal Opportunity Employer.

High school diploma or GED and two years related experience and/or training, or equivalent combination of education and experience.

Ability to enter and retrieve data using standardized keyboard functions.

Ability to read and interpret technical procedures or government regulations.

Ability to write basic correspondence and perform basic arithmetic.

Specialized claims or membership processing training or experience.