The Manager, Claims implements end to end service model across provider segments and ensures delivery against business targets. The role sets performance and process targets within customer segment(s) to enable high level of claims processing, claims financial processing, and customer service. Manages claims submission, refunds, and recovery from all lines of business for assigned customer segment(s). Collaborates with claims leadership to understand customer segment(s) and contractual obligations. This role is also responsible for claims accounting and financial reporting.
What You'll Do
Streamline shared processing to reduce management by exception
Set operational process to address market trends, BCBSNC capabilities and customer demand
Manage accounting and financial reporting functions in support of the Finance Division including overseeing the gathering, preparation, analysis, and reconciliation of financial data to ensure compliance with accepted accounting principles and standards.
Research and resolve banking issues.
Participate in projects to improve and/or facilitate claims processing, recovery, and accounting functions.
Manage financial recovery activities including refunds and collections
Manage team leads and staff by efficiently driving work volume to keep high level of utilization and engagement in the group
Resolve complex claims appeal by coordinating with different stakeholders for certain high value claims
Collaborate with Audit and Payment Integrity to sustain a pre-determined level of accuracy and quality
Design and develop tools and techniques for improvements. Identifies needed process and procedural changes which will result in improved customer satisfaction.
Negotiate Claims ASO performance guarantees, reviews, approvals, and client RFPS in collaboration with Sales organization
Serve as ASO Claims Subject Matter Expert and single point of contact for performance monitoring and troubleshooting.
Represent Claims Operations to ASO executives providing data, reports, analytics, and expertise routinely and on demand.
Support ASO Channel lead serving as the Claims ASO Subject Matter Expert and acting as single point of contact both internally and to the ASO for all Claims, Claims Recovery, and Claims Accounting related escalations.
What You Need
Bachelor's degree or advanced degree (where required)
8+ years of experience in related field.
In lieu of degree, 10+ years of experience in related field.
Bonus
Demonstrated claims operations experience in a regulated claims environment (Medicare, government programs, or similar).
Experience leading claims teams and performance management.
Proven understanding of claims systems and processing workflows
Data analytics and reporting experience.
Experience with Facets or similar claims platforms strongly preferred.
What You’ll Get
The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community
Work-life balance, flexibility, and the autonomy to do great work
Medical, dental, and vision coverage along with numerous health and wellness programs
Parental leave and support plus adoption and surrogacy assistance
Career development programs and tuition reimbursement for continued education
401k match including an annual company contribution
Salary Range
At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.
*Based on annual corporate goal achievement and individual performance.
$107,901.00 - $172,642.00
Skills
Accounts Receivable (AR), Claims Analysis, Claims Management, Claims Processing, Claims Resolution, Claims Submission, Documentations, Financial Processing, Health Insurance, Insurance Claim Handling, Insurance Claims Processing, Insurance Industry, Medicare Advantage, People Management, Recruiting
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JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: HR.Staffing@BCBSNC.com
It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians.
Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all.
Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.
Blue Cross NC is an independent licensee of the Blue Cross and Blue Shield Association.
