Claims Systems Lead (Hybrid) - Oversight & Improvement

ADP; King of Prussia (PA); Hybrid; USD 90,000 - 120,000; Full time

Benefits offered by this job

Competitive base pay

Annual bonus

Medical plans

Parental leave

Wellness support

International healthcare coverage

401(k) with match

Pet insurance

ID theft protection

Job summary

Blue Cross Blue Shield Global Solutions SM in King of Prussia, PA, is seeking a Supervisor of Claims Systems to oversee daily operation and hands-on configuration of claims platforms. You will coordinate system changes, testing, and validation while ensuring regulatory compliance and collaboration with IT, Product, Enrollment, and Finance teams.

You will lead a team of analysts, manage risk and audits, and drive continuous improvement in claims processing systems, including Actisure and

Qualifications

• 1+ years of leadership experience.
• 2+ years in claims operations, claims systems, or business systems analysis.
• Experience working with claims administration platforms (e.g., Actisure, Guidewire, or similar systems).
• Experience supporting system implementations, enhancements, and testing activities.
• Proficiency in data analysis and reporting (e.g., Excel, SQL, or similar tools).

Responsibilities

• Oversee daily operation and performance of claims administration systems, including Actisure and related platforms.
• Perform hands-on system configuration and maintenance, including benefit plans, provider setup, code sets, user roles, permissions, and claims correspondence.
• Lead system build, testing, and validation activities.
• Ensure alignment between Enrollment and Claims for eligibility, benefits, and adjudication logic.
• Collaborate with IT, Product, Enrollment, Finance, Compliance, and vendors on system enhancements, upgrades, integrations, and defect resolution.
• Lead and execute user acceptance testing (UAT), including test planning, scripting, execution, and defect resolution and support implementation readiness and perform post-release validation activities.
• Serve as a primary point of contact for Claims Systems-related questions, issues, and initiatives.

Skills

Leadership

Claims systems

System analysis

UAT testing

Data analysis

SQL

Regulatory compliance

Tools

Actisure

Guidewire

Job description

Blue Cross Blue Shield Global Solutions SM in King of Prussia, PA, is seeking a Supervisor of Claims Systems to oversee daily operation and hands-on configuration of claims platforms. You will coordinate system changes, testing, and validation while ensuring regulatory compliance and collaboration with IT, Product, Enrollment, and Finance teams.

You will lead a team of analysts, manage risk and audits, and drive continuous improvement in claims processing systems, including Actisure and