Claims Bluecard Analyst IV, Lead
New
H
Healthcare Management AdministratorsHealth Plan Administration
We hire people from across the US (excluding the state of Hawaii and the cities of Los Angeles and San Francisco.), Supports people in all time zones across the US.Full-TimeLead
Salary$47.89/hr - $55.76/hr
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Job Details
- Experience
- 5-7+ years of claims processing experience; 3-5 years of BCBS claims processing experience; 1+ years of leadership experience.
- Required Skills
- LeadershipData AnalysisMicrosoft Excel
Requirements
- High school diploma required; Associate’s Degree preferred.
- 5-7+ years of claims processing experience within the insurance industry.
- 3-5 years of BCBS claims processing experience.
- 1+ years of proven leadership experience.
- Expert Excel skills with the ability to manipulate data independently.
- Expert-level understanding of ITS/BlueCard processing, pricing methodologies, and BCBS national programs.
- Strong leadership, communication, and coaching abilities.
- Ability to manage competing priorities and support team performance.
- High-level analytical skills with the ability to interpret data and drive improvements.
Responsibilities
- Monitor BlueWeb for Association updates and analyze release notes to determine impacts on claims, pricing, and training.
- Serve as a Subject Matter Expert on BlueCard/ITS claims processing rules and coach team members on program requirements.
- Coordinate Association projects and rule interpretation with Regence and InterPlan stakeholders.
- Oversee complex ITS/BlueCard workflows and lead system and pricing enhancement projects.
- Conduct root-cause analysis on recurring issues and implement operational improvements.
- Monitor InterPlan Program (IPP) performance metrics and lead improvement initiatives.
- Oversee daily ITS claims adjudication and serve as a primary escalation point for complex claim issues.
- Act as a liaison with BCBS host/home plans and external partners.
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