Claims Ops Lead, Reimbursement Programs (Remote)

Excellus BCBS; United States; Remote; USD 65,000 - 118,000; Full time

Job summary

Excellus BCBS is seeking a leadership-level professional to oversee the Reimbursement Claims Processing Team responsible for facilitating and substantiating all claims across multiple account types including FSA, HSA, HRA, transit, parking, and wellness benefits.

The role focuses on managing personnel, ensuring production standards, and driving process improvements while maintaining strict privacy and regulatory compliance.

Qualifications

• Five or more years of related work experience, three or more in healthcare or reimbursement claims processing operations.
• Experience supervising or managing people and/or projects or indirectly leading teams.
• Knowledge and application of IRC Sections (e.g., 105, 125, 129) regulations that apply to benefit administration.
• Ability to make prudent and well-researched decisions with impact awareness.
• Good organizational skills and ability to prioritize assignments.
• Ability to establish and maintain working relationships with internal and external stakeholders.
• Intermediate to advanced Excel skills; familiarity with Outlook and Word.

Responsibilities

• Oversee daily activities of the claims processing team, including hiring, onboarding, training, and performance appraisals.
• Plan, coordinate, monitor, and report on team activities to meet production and regulatory standards.
• Develop and monitor workflows, metrics, audits, and procedures for efficiency and compliance.
• Address backlogs and inventory concerns; implement process improvements.
• Lead system enhancements, release testing, and other department projects.
• Provide client/broker/member support as needed for special projects and training.

Skills

Leadership experience

Organizational skills

Regulatory knowledge

Excel skills

Communication skills

IRC knowledge

Microsoft Outlook

Microsoft Word

Tools

Microsoft Outlook

Microsoft Word

Job description

Excellus BCBS is seeking a leadership-level professional to oversee the Reimbursement Claims Processing Team responsible for facilitating and substantiating all claims across multiple account types including FSA, HSA, HRA, transit, parking, and wellness benefits.

The role focuses on managing personnel, ensuring production standards, and driving process improvements while maintaining strict privacy and regulatory compliance.