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Bcbs Claims Jobs in Raleigh, NC (NOW HIRING)

REVCO SOLUTIONS INC

Insurance Team Lead

Durham, NC · On-site

Requirements: · Extensive experience with Insurance Claims, Billing, and Insurance Follow-Up. · Detail oriented and correspond professionally. · Must have Anthem BCBS experience.

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Bcbs Claims information

See Raleigh, NC salary details

$11

$23

$40

How much do bcbs claims jobs pay per hour?

As of Aug 10, 2026, the average hourly pay for bcbs claims in Raleigh, NC is $23.45, according to ZipRecruiter salary data. Most workers in this role earn between $17.74 and $26.63 per hour, depending on experience, location, and employer.

What are BCBS claims?

BCBS claims refer to the requests for payment that healthcare providers submit to Blue Cross Blue Shield (BCBS) insurance on behalf of patients who have received medical services. These claims include details about the patient's treatment, diagnosis, and the costs incurred. Once submitted, BCBS reviews the claim to determine which services are covered under the patient’s insurance plan and how much will be paid to the provider. The process also helps ensure that policyholders receive their benefits according to their health plan. Proper claims handling is essential for timely reimbursements and efficient healthcare administration.

What are the key skills and qualifications needed to thrive as a BCBS claims specialist?

To thrive as a BCBS Claims Specialist, you need a solid understanding of health insurance policies, medical billing, and claims processing, typically supported by experience in healthcare administration or a related field. Familiarity with claims management software, ICD-10/CPT coding systems, and electronic data interchange (EDI) platforms is essential. Strong attention to detail, analytical thinking, and effective communication are crucial soft skills for resolving discrepancies and assisting clients or providers. These skills ensure accurate claims adjudication, regulatory compliance, and efficient resolution of issues within the health insurance process.

What are some common challenges faced by professionals handling BCBS claims, and how can they be managed effectively?

Professionals working with BCBS (Blue Cross Blue Shield) claims often encounter challenges such as navigating complex insurance policies, ensuring accurate coding, and managing claim denials or rejections. Staying up to date with changing regulations and payer requirements is crucial to avoid processing errors. Effective communication with healthcare providers and insurance representatives, along with strong attention to detail, can help resolve discrepancies quickly and ensure timely claim resolution. Utilizing claim management software and participating in ongoing training are also beneficial for staying efficient and compliant.

What is the difference between Bcbs Claims vs Bcbs Customer Service Representative?

AspectBcbs ClaimsBcbs Customer Service Representative
Required CredentialsInsurance claims processing certification, knowledge of healthcare policiesCustomer service training, communication skills, insurance knowledge
Work EnvironmentOffice setting, claims processing departmentsCall centers, customer support centers
Employer & Industry UsageHealth insurance companies, healthcare industryHealth insurance companies, customer support roles
Common Search & ComparisonClaims processing, insurance claimsCustomer support, member inquiries

While Bcbs Claims specialists focus on processing and managing insurance claims, Bcbs Customer Service Representatives handle member inquiries and support. Both roles are essential in the healthcare insurance industry but differ in responsibilities and daily tasks.

What are popular job titles related to Bcbs Claims jobs in Raleigh, NC? For Bcbs Claims jobs in Raleigh, NC, the most frequently searched job titles are:
What job categories do people searching Bcbs Claims jobs in Raleigh, NC look for? The top searched job categories for Bcbs Claims jobs in Raleigh, NC are:
What cities near Raleigh, NC are hiring for Bcbs Claims jobs? Cities near Raleigh, NC with the most Bcbs Claims job openings:
Bcbs Claims jobs near you
Infographic showing various Bcbs Claims job openings in Raleigh, NC as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $48,779 per year, or $23.5 per hour.

Insurance Follow-Up Specialist

REVCO SOLUTIONS INC

Durham, NC • On-site

Full-time

Re-posted 24 days ago

Job description

Description:

APPLY TODAY!! Full-Time Remote Insurance Follow-Up Specialist


Position Description:

The Insurance Follow-Up Specialist is responsible for ensuring the timely and accurate resolution of outstanding insurance claims. This role involves investigating and resolving unpaid or underpaid claims by communicating with insurance carriers, identifying billing issues, and initiating corrective actions. The specialist plays a critical role in maximizing reimbursement and supporting the overall revenue cycle by maintaining detailed documentation and adhering to regulatory and payer-specific guidelines.


Duties & Responsibilities:

  • Conduct detailed analysis and follow-up on outstanding insurance claims (both commercial and government), ensuring timely and accurate resolution in accordance with payer guidelines.
  • Research and resolve claim denials, rejections, and underpayments by initiating appropriate billing corrections, appeals, and resubmissions.
  • Prepare and submit claim documentation—including EOBs, itemized statements, and medical records—as required by payers to support claim adjudication.
  • Respond to payer and patient inquiries related to delinquent claims, maintaining compliance with privacy regulations and payer contract guidelines.
  • Utilize payer portals, Electronic Health Records (EHR), and patient accounting systems to investigate claim status, post notes, and manage follow-up activities.
  • Identify trends in denials and payment delays, contributing to process improvement initiatives and strategies for reducing AR days.
  • Maintain accurate and detailed records of account activity, ensuring that production goals and quality standards are consistently met or exceeded.
  • Demonstrate strong communication skills when interacting with insurance representatives, patients (as appropriate), and internal departments to resolve outstanding issues.
  • Prioritize and organize daily workload effectively to meet departmental benchmarks in a fast-paced, high-volume environment.
  • · Provide support on special projects and additional assignments as requested by management
Requirements:
  • 2 years of previous experience working with commercial or other third-party insurance claims, medical billing/follow-up, BCBS experience is a plus
  • An understanding of various forms, codes (CPT & ICD), insurance terminology and insurance company remittance advice
  • EPIC experience preferred but not required
  • Certificates, Licenses, Registrations, and/or Medicare certification are a plus, but not required