BlueCard Claims Analyst – Data-Driven Optimizer

Intepros; Philadelphia (Philadelphia County); On-site; USD 75,000 - 115,000; Full time

Job summary

Intepros in Philadelphia, PA is seeking a Business Analyst to support BlueCard claims operations. The role focuses on analyzing and resolving complex claims issues, improving processes, and leveraging data and technology to enhance the claims experience.

The ideal candidate has at least 3+ years in medical claims processing, strong knowledge of BlueCard products, and proficiency with Excel, SQL, and MS Access. Excellent problem-solving, communication, and attention to detail are essential.

Qualifications

• 3+ years of experience in medical claims processing/adjusting or healthcare administration.

Responsibilities

• Analyze claim issues and inquiries, perform root-cause analysis, and drive issues through resolution.
• Research incorrectly processed claims and failed DF/RFs, identify solutions, and coordinate claim repair or system enhancements.
• Partner with internal teams and other Blue plans to resolve member and claims-processing discrepancies.
• Communicate with other plans through the BCBSA Blue Squared application (RTM).
• Evaluate current workflows and identify opportunities to improve claims processing through data, automation, bots, and other technology solutions.
• Pull, analyze, and summarize claims and operational data to identify trends, errors, and process improvement opportunities.
• Develop, test, implement, and maintain process and technology improvements.
• Document processes, procedures, findings, and recommended solutions.
• Serve as a departmental SME in meetings, projects, and cross-functional initiatives.
• Collaborate closely with Claims Processing, Configuration, Account Management, and other business partners.

Skills

Medical claims processing

BlueCard operations

Blue Squared application

Billing and coding (ICD-10, CPT, HCPCS

Root-cause analysis

Data analysis

Excel/Word/PowerPoint

SQL / Microsoft Access

Communication skills

Attention to detail

Independent worker

Tools

Excel

Word

PowerPoint

SQL

Microsoft Access

Job description

Intepros in Philadelphia, PA is seeking a Business Analyst to support BlueCard claims operations. The role focuses on analyzing and resolving complex claims issues, improving processes, and leveraging data and technology to enhance the claims experience.

The ideal candidate has at least 3+ years in medical claims processing, strong knowledge of BlueCard products, and proficiency with Excel, SQL, and MS Access. Excellent problem-solving, communication, and attention to detail are essential.