CareFirst Careers

Claims Processor 1

Resp & Qualifications

Under the direction of the Manager/Supervisor, the essential duties and responsibilities include, but are not limited to, the following:

  • Examines claims to identify key elements and processing requirements based on diagnosis, provider, paykey, medical policy, contracts, and policies and procedures.  Efficiently and accurately processes product- or system-specific claims to ensure timely payments are generated.  Calculates deductibles and maximums, as well as researches and resolves system pends.
  • Processes lower dollar volume claims adjustments in accordance with standard policies and procedures to resolve over and underpayments.
  • Assists Customer Service Reps by providing feedback and resolving issues and answering basic processing questions.
  • Gathers productivity data and compiles weekly and monthly reports on own performance.  Reports are used by management to plan for scheduling, quality improvement initiatives, workflow design, financial planning, etc.


Required:  High school degree plus demonstrated work experience beyond high school.

Abilities/Skills:  Demonstrated mathematical, problem-solving, data entry/PC, stress management, and organizational skills.  Basic written/oral communication skills.

Preferred:  Claims processing, billing, or medical terminology experience.


Department: NASCO Claims - Cumberland

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply:

Closing Date

Please apply before: 6/17/21

Federal Disc/Physical Demand

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.


The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

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