Manager, Claims

🕒 August 19

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $107.9k - $172.6k / year

⏰ Full Time

🟠 Senior

🔴 Lead

👔 Manager

👻 Ghost score 44%

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

• Implement an end-to-end service model across provider segments and ensure delivery against business targets • Set performance and process targets for customer segments • Manage claims submission, refunds, recovery, and collections across lines of business • Oversee claims accounting and financial reporting, including gathering, preparing, analyzing, and reconciling financial data • Research and resolve banking issues • Participate in projects improving claims processing, recovery, and accounting functions • Manage financial recovery activities • Manage team leads and staff, driving work volume, utilization, and engagement • Resolve complex claims appeals by coordinating with stakeholders • Collaborate with Audit and Payment Integrity to maintain accuracy and quality • Design and develop tools and identify process and procedural improvements • Negotiate ASO performance guarantees and review approvals and client RFPs with Sales • Serve as ASO Claims subject matter expert and point of contact for monitoring and troubleshooting • Represent Claims Operations to ASO executives with data, reports, analytics, and expertise • Support the ASO Channel lead with claims-related escalations

🎯 Requirements

• Bachelor's degree or advanced degree (where required), or 10+ years of experience in lieu of degree • 8+ years of experience in related field • 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 • Claims accounting and financial reporting knowledge • Knowledge of accepted accounting principles and standards • Experience with claims submission, refunds, recovery, and collections • Experience with claims appeals and stakeholder coordination • Experience negotiating ASO performance guarantees and reviewing approvals and client RFPs

🏖️ 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 • 401k match including an annual company contribution • Annual Incentive Bonus • Paid Time Off (PTO)