Job Title Accumulations Team Member

Job Description

The Accumulations Team is responsible for managing and maintaining member accumulations by researching, auditing, updating and posting data to ensure accurate deductible and out-of-pocket balances. In this role you will monitor inventory, track aging, prioritize audit requests, and process member accumulation transfers between plans according to system guidelines. Additionally, the team member collaborates with business partners, assists with audits and remediation efforts, supports training and serves as a subject matter expert for testing and documentation reviews. The Accumulations Team Member will report to the Claims Operations Supervisor. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Responsibilities

In this role, you will: Research accumulations and update accordingly Independently process complex and high-risk claims across multiple products or specialties Pull, format and send reporting to necessary teams Reviews applications and recommends system edits/changes as needed Be given special processing assignments; coordinate with other departments for resolution if needed Consistently exceed performance metrics and quality standards Manage time effectively, multi-task, demonstrate detailed research skills, meet deadlines with excellent quality Serve as a subject matter resource for selected claim types, providing guidance to peers Identify, analyze, and resolve system and processing errors with minimal escalation Assist with training, documentation review, and workflow support; act as backup to lead roles Other duties as assigned

Qualifications

Your Knowledge and Experience: High School Diploma or GED or 1 year of additional relevant experience in lieu of a diploma required 5 years of previous experience required Requires broad knowledge of operational systems and practices within Claims Processing Proficiency in front and back-end processing with the ability to not only identify errors but to analyze and resolve them Demonstrated ability in processing multiple claim types or specialties Deep understanding of end-to-end claims processing fundamentals Intermediate-Advanced skills creating documents/files using Excel, Outlook, Power Point, and Word Ability to work independently as well as in a team environment Strong ability to manage time effectively and detailed research skills Hybrid This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week. Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.

About Us

About Blue Shield of California As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies. At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience. To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals. Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us! Our Values: Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short. Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives. Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals. Our Workplace Model We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility: For most teams, this means coming into the office two days per week. Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need. For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being. The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews. Physical Requirements: Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day. Please click here for further physical requirement detail. Equal Employment Opportunity: External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws. Job Info Job Identification 20261531 Job Category Customer Services and Operations Posting Date 10/19/2026, 03:43 PM Job Schedule Full time Locations Redding, CA, United States Lodi, CA, United States Rancho Cordova, CA, United States Pay Range for California $22.51 to $31.52 Pay Range for Bay Area $25.38 to $35.53 Note Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate experience, location (California, Bay Area, or outside California), and current employee salaries for similar roles. Role can be filled by a candidate requiring sponsorship No