**Hybrid Work Environment - Must reside in Hawaii **

Develop the basic knowledge and skills required to effectively process routine and regular claims and claim inquiries submitted through the BlueCard Unit which administers inter-plan (Blue plan to Blue plan) processing.

A BlueCard Home examiner processes claims and inquiries for HMSA (Blue Cross Blue Shield of Hawai'i) members receiving medical services outside the State of Hawai'i. A BlueCard Host examiner processes claims and inquiries for members of other Blue Cross and Blue Shield Plans receiving services in the State of Hawai'i.

• Successfully complete on the job training in the following areas:
  • Basic claims processing:
    • Provider/member eligibility
    • Basic payment and reimbursement policies for Host processing, or medical, reimbursement, and benefit policies for Home processing
    • COB processing - interpret COB values submitted to accurately pass data for Host processing, or coordinate and apply benefits for Home processing
    • Use of systems, reference databases (e.g. provider or membership), applications and tools to research claims questions and inquiries
    • Resolution of routine system and adjudication edits using HMSA internal claims systems.
  • BlueCard specific training:
    • BlueCard Program, processing standards, policies, inter-plan processing requirements and resources.
    • Use if ITS and Blue2 systems which specifically supports inter-plan processing. Knowledge of ITS specific coding structure, data values, system transactions and the requirements of each unique transaction to support the different types of claims processing and communications between plans
    • Prioritization of work to meet Inter-plan Performance measures

• Via the Blue2 system or emails, initiate or respond to contacts with other Blue plans to resolve claims inquiries, or requests

• Innovation, process improvement activities

• As needed, via simple/routine verbal or written communication:
  • Coordinate with internal departments.
  • Contact providers' offices or other Blue Plans.

• Complete or participate in corporate training, compliance certification or initiatives as directed by management.

• Performs all other miscellaneous responsibilities and duties as assigned or directed.