Claims Operations Leader: Strategy, Recovery & Analytics

Blue Cross and Blue Shield of North Carolina; Raleigh (NC); On-site; USD 108,000 - 173,000; Full time

Benefits offered by this job

401(k) match including an annual 회사con

Paid Time Off (PTO)

Competitive health benefits and welln

Tuition reimbursement

Job summary

Blue Cross NC seeks a Manager, Claims to lead end-to-end service across provider segments and ensure delivery against business targets. You will oversee claims processing, refunds, and recovery, collaborating with leadership on performance and contractual obligations.

The role also covers claims accounting, financial reporting, and acting as the SME for ASO performance monitoring. Strong leadership and analytics are essential to drive improvements and customer satisfaction.

Qualifications

• 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.

Responsibilities

• Streamline shared processing to reduce management by exception.
• Set operational process to address market trends, BCBSNC capabilities and customer demand.
• Manage accounting and financial reporting functions in support of the Finance Division including overseeing the gathering, preparation, analysis, and reconciliation of financial data to ensure compliance with accepted accounting principles and standards.
• Research and resolve banking issues.
• Participate in projects to improve and/or facilitate claims processing, recovery, and accounting functions.
• Manage financial recovery activities including refunds and collections
• Manage team leads and staff by efficiently driving work volume to keep high level of utilization and engagement in the group
• Resolve complex claims appeal by coordinating with different stakeholders for certain high value claims
• Collaborate with Audit and Payment Integrity to sustain a pre-determined level of accuracy and quality
• Design and develop tools and techniques for improvements. Identifies needed process and procedural changes which will result in improved customer satisfaction.
• Negotiate Claims ASO performance guarantees, reviews, approvals, and client RFPS in collaboration with Sales organization
• Serve as ASO Claims Subject Matter Expert and single point of contact for performance monitoring and troubleshooting.
• Represent Claims Operations to ASO executives providing data, reports, analytics, and expertise routinely and on demand.
• Support ASO Channel lead serving as the Claims ASO Subject Matter Expert and acting as single point of contact both internally and to the ASO for all Claims, Claims Recovery, and Claims Accounting related escalations.

Skills

Accounts Receivable

Claims Analysis

Claims Management

Claims Processing

Claims Resolution

Claims Submission

Documentations

Financial Processing

Health Insurance

Insurance Claims

Medicare Advantage

People Management

Recruiting

Education

Bachelor's degree

Advanced degree

Tools

Facets

Job description

Blue Cross NC seeks a Manager, Claims to lead end-to-end service across provider segments and ensure delivery against business targets. You will oversee claims processing, refunds, and recovery, collaborating with leadership on performance and contractual obligations.

The role also covers claims accounting, financial reporting, and acting as the SME for ASO performance monitoring. Strong leadership and analytics are essential to drive improvements and customer satisfaction.