FEP Claims & Financial Operations Manager

Blue Cross NC; North Carolina; Hybrid; USD 108,000 - 173,000; Full time

Job summary

Blue Cross NC is seeking a FEP Manager, Claims to drive end-to-end service across provider segments, managing claims processing, refunds, and recovery while ensuring financial reporting accuracy. You will lead performance targets, collaborate with leadership, and act as SME for all FEP Claims escalations.

The role emphasizes managing complex settlements, collaborating with Audit and Payment Integrity, and delivering process improvements to enhance customer satisfaction.

Qualifications

• Bachelor's degree or advanced degree required or alternative 10+ years of related experience.
• Related field experience: 8+ years with a Bachelor's or 10+ years without a degree.

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.
• Represent FEP Claims Operations when providing data, reports, analytics, and expertise routinely and on demand.
• Serve as the Claims FEP Subject Matter Expert and acting as single point of contact both internally and externally for all FEP Claims, Claims Recovery, and Claims Accounting related escalations.

Education

Bachelor's degree or advanced degree

In lieu of degree, 10+ years of experience in related field

Job description

Blue Cross NC is seeking a FEP Manager, Claims to drive end-to-end service across provider segments, managing claims processing, refunds, and recovery while ensuring financial reporting accuracy. You will lead performance targets, collaborate with leadership, and act as SME for all FEP Claims escalations.

The role emphasizes managing complex settlements, collaborating with Audit and Payment Integrity, and delivering process improvements to enhance customer satisfaction.