Claims Operations Manager - Autonomy & Growth

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

Benefits offered by this job

Medical, dental, and vision coverage

Parental leave and surrogacy support

Tuition reimbursement and career dev.

401k match and company contribution

Work-life balance and flexibility

Job summary

Blue Cross NC is seeking a Manager, Claims to lead end-to-end service delivery across provider segments and drive performance targets for claims processing, refunds, and recovery. You will oversee accounting, financial reporting, and collaboration with claims leadership to meet business goals.

The role requires a Bachelor's or higher degree with 8+ years in related fields, or 10+ years of experience in lieu of degree. Strong analytics and stakeholder coordination are essential.

Qualifications

• Bachelor's degree or advanced degree as required.
• 8+ years of related field experience.
• In lieu of degree, 10+ years of related field experience.

Responsibilities

• Streamline shared processing to reduce management by exception.
• Set operational processes to address market trends, BCBSNC capabilities and customer demand.
• Manage accounting and financial reporting functions in support of the Finance Division including gathering, preparation, analysis, and reconciliation of financial data.
• 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 maintain high utilization and engagement.
• Resolve complex claims appeals by coordinating with stakeholders for high-value claims.
• Collaborate with Audit and Payment Integrity to sustain accuracy and quality.
• Design and develop tools and techniques for improvements; identify needed process changes.
• Negotiate Claims ASO performance guarantees, reviews, approvals, and client RFPS with Sales.
• 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.
• Support ASO Channel lead as SME and single point of contact for Claims, Recovery, and Accounting escalations.

Skills

Accounts Receivable

Claims Analysis

Claims Management

Claims Processing

Claims Resolution

Financial Processing

Health Insurance

Medicare Advantage

People Management

Recruiting

Education

Bachelor's degree or advanced degree

Tools

Facets or similar

Job description

Blue Cross NC is seeking a Manager, Claims to lead end-to-end service delivery across provider segments and drive performance targets for claims processing, refunds, and recovery. You will oversee accounting, financial reporting, and collaboration with claims leadership to meet business goals.

The role requires a Bachelor's or higher degree with 8+ years in related fields, or 10+ years of experience in lieu of degree. Strong analytics and stakeholder coordination are essential.