Financial Claims Associate

🔥 12 hours ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $50.3k - $80.5k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

📋 Claims Specialist

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Blue Cross NC

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 1933

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Blue Cross NC is a health insurance provider that offers a range of health plans and services to individuals and groups. The company focuses on delivering quality healthcare coverage and improving health outcomes for its members through innovative health programs and services. Blue Cross NC is committed to enhancing access to affordable healthcare while supporting the health and wellness of the communities it serves.

📋 Description

• Perform financial claims expense invoicing, reporting, analysis, reimbursement determination, and forecasting • Prepare financial claims expense invoices, weekly statements, forecasts, schedules, and month-end close materials • Analyze and present historical and forecasted claims expense and stop loss coverage information • Prepare loss coverage financials for employer groups and stop loss vendors • Review employer group subgroup expenditures for compliance with Administrative Agreements • Prepare reports and variance analyses for employer groups, stop loss vendors, Sales, Underwriting, and other audiences • Verify manual transaction fees and contractual adjustments • Prepare estimates and adjustments for new and existing business • Reconcile statements of account and assist with monthly run-out and final close-out activities • Compile data for internal and external audits • Process claims-related client transactions, including claim holds, run-out administrative fees, and employer group settlements • Determine stop loss coverage eligibility for claims based on contract terms • Research utilization, provider information, medical reviews, leave-of-absence language, COBRA benefits, and plan documentation • Perform quality reviews of operational inquiries to ensure accurate information and expected service levels

🎯 Requirements

• Bachelor's degree or advanced degree (where required), or 3+ years of experience in a related field in lieu of degree • 0-2 years of experience in a related field • Ability to perform financial claims expense invoicing, reporting, analysis, reimbursement determination, and forecasting • Ability to prepare financial claims expense reports, weekly invoices, statements, forecasts, and reconciliations • Ability to research claims, plan policies, products, rates, membership, enrollment, underwriting, direct sales, contracts, and program engagement • Ability to analyze stop loss coverage, high-dollar claims, claimants' performance, trends, and contractual adjustments • Ability to determine stop loss benefit eligibility based on contract terms • Ability to support audits, variance analysis, quality reviews, and client transactions

🏖️ Benefits

• Work-life balance, flexibility, and autonomy • Medical, dental, and vision coverage • Health and wellness programs • Parental leave and support • Adoption and surrogacy assistance • Career development programs • Tuition reimbursement for continued education • 401(k) match including an annual company contribution • Paid Time Off (PTO) • Annual Incentive Bonus • Remote work with a few in-office visits each year for meaningful moments