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Senior Claims Processor – Anthem BlueCard PPO

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Job Title: Senior Claims Processor – Anthem BlueCard PPO
Location: Remote
Employment Type: Full-Time

About the Role
We are seeking a highly skilled Senior Claims Processor with specialized expertise in Anthem BlueCard PPO claims. The ideal candidate will have at least 5+ years of hands-on experience processing BlueCard PPO claims with accuracy and compliance. This role requires advanced knowledge of CMS and payer-specific guidelines, strong analytical skills, and the ability to resolve complex claim issues while mentoring junior processors.

Key Responsibilities

  • Review, analyze, and process Anthem BlueCard PPO claims, including institutional, professional, outpatient, and inpatient claims.
  • Apply CMS, Medicare, Medicaid, and commercial payer guidelines to ensure compliance.
  • Accurately adjudicate claims using ICD-10, CPT, HCPCS, and coding modifiers.
  • Resolve denials, escalations, and exceptions with sound judgment.
  • Utilize claims processing systems (Facets, Epic, QNXT, or similar) and EHR/billing platforms.
  • Collaborate with providers, facilities, and internal teams to address claim issues.
  • Stay current on payer policy changes and apply them effectively.
  • Mentor and support junior processors, providing training and sharing best practices.
  • Maintain HIPAA compliance while processing a high volume of claims with accuracy.

Qualifications

  • 5+ years of Anthem BlueCard PPO claims processing experience (required).
  • Strong understanding of CMS guidelines and payer-specific requirements.
  • Proficient with ICD-10, CPT, HCPCS coding, and claims adjudication.
  • Hands-on experience with claims platforms (Facets, Epic, QNXT, or similar).
  • Skilled in Excel, Outlook, Teams, and other data review tools.
  • Strong communication skills for provider and internal team interactions.
  • Proven problem-solving and critical-thinking ability in high-volume claim environments.
  • Experience mentoring and training team members.
  • Attention to detail with a commitment to compliance and accuracy.

Why Join Us?

  • 100% remote work environment
  • Opportunity to specialize in complex Anthem BlueCard PPO claims
  • Collaborative team culture with leadership opportunities
  • Professional growth and development support

Job Type: Full-time

Pay: $25.00 - $35.00 per hour

Expected hours: 40 per week

Benefits:

  • Dental insurance
  • Life insurance
  • Paid time off
  • Vision insurance
  • Work from home

Work Location: Remote

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