Lead Claims Bluecard Analyst

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🔥 3 minutes ago

☕ Washington – Remote

☕ Washington – Remote

💵 $47 - $55 / hour

⏰ Full Time

🟠 Senior

📋 Claims Specialist

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Healthcare Management Administrators

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1986

⚕️ Healthcare Insurance

🤝 B2B

Healthcare Insurance • B2B

<Healthcare Management Administrators> is a service-oriented health plan administrator that designs and delivers high-quality, affordable self-funded health plans for employers. The company provides benefits administration, member portals, customer care, and access to a large provider network in the Pacific Northwest, helping employers manage claims, ID cards, provider search, and care navigation. HMA focuses on improving member outcomes and reducing employer health plan costs through proactive, people-first solutions and experienced plan management.

📋 Description

• Monitor BlueWeb for Association updates and analyze release notes to determine claim, pricing, and training impacts. • Track provider terminations and communicate impacts; coordinate continuity-of-care and disruption analysis. • Serve as SME on BlueCard/ITS claims processing rules and operational program requirements. Coach team members accordingly on guidelines and changes. • Coordinate Association projects and rule interpretation with Regence and InterPlan Executives. • Act as key escalation point for Plan-to-Plan issues. • Cascade InterPlan communications to internal teams. • Oversee complex ITS/BlueCard workflows; lead system and pricing enhancement projects. • Test and validate system updates; refine ITS/BlueCard policies and procedures. • Conduct root-cause analysis on recurring issues and implement improvements. • Monitor and communicate InterPlan performance metrics (IPP). • Track quality and productivity metrics; lead improvement initiatives. • Oversee daily ITS claims workflows and ensure timely, accurate adjudication across all claim types. • Serve as the primary escalation point for the most complex, sensitive, or high-impact ITS/BlueCard claim issues. • Partner with leadership to refine ITS policies, update procedures, and support operational strategy. • Act as a liaison with BCBS host/home plans and external partners for escalated claim issues.

🎯 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.

🏖️ Benefits

• Seventeen (IC) days paid time off (individual contributors) • Eleven paid holidays • Two paid personal and one paid volunteer day • Company-subsidized medical, dental, vision, and prescription insurance • Company-paid disability, life, and AD&D insurances • Voluntary insurances • HSA and FSA pre-tax programs • 401(k)-retirement plan with company match • Annual $500 wellness incentive and a $600 wellness reimbursement • Remote work and continuing education reimbursements • Discount program • Parental leave • Up to $1,000 annual charitable giving match