Manager, Claims

Job not on LinkedIn

🔥 0 minutes ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $107.9k - $172.6k / year

⏰ Full Time

🟠 Senior

🔴 Lead

👔 Manager

👻 Ghost score 0%

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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, claims accounting, and financial reporting • Streamline shared processing and address market trends, capabilities, and customer demand • Oversee gathering, preparation, analysis, and reconciliation of financial data • Research and resolve banking issues • Participate in projects improving claims processing, recovery, and accounting functions • Manage financial recovery activities, including refunds and collections • Manage team leads and staff while 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 techniques for process improvements • Identify process and procedural changes to improve customer satisfaction • Negotiate Claims ASO performance guarantees, reviews, approvals, and client RFPs with Sales • Serve as Claims ASO subject matter expert and point of contact for performance monitoring and troubleshooting • Represent Claims Operations to ASO executives with data, reports, analytics, and expertise • Support the ASO Channel lead on Claims, Claims Recovery, and Claims Accounting escalations

🎯 Requirements

• 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 • 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 • Authorization to work in the United States

🏖️ 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 • Paid Time Off (PTO) • Annual Incentive Bonus based on annual corporate goal achievement and individual performance