Senior Claims Processor Anthem BlueCard PPO

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 Compensation: $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 Apply tot his job Apply tot his job Apply tot his job Apply tot his job Apply To this Job Company : careerwave.lovestoblog Salary : Work from home .