Claims Specialist

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/13605718 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