FEP Manager, Claims

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

Job Description

The FEP Manager, Claims implements end to end service model across provider segments and ensures delivery against business targets. The role sets performance and process targets within customer segment(s) to enable high level of claims processing, claims financial processing, and customer service. Manages claims submission, refunds, and recovery from all lines of business for assigned customer segment(s). Collaborates with claims leadership to understand customer segment(s) and contractual obligations. This role is also responsible for claims accounting and financial reporting.

What You’ll Do

• 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.

What You Bring

• 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.

Bonus Points

• Experience supporting Federal Employee Program (FEP) claims operations
• Strong knowledge of healthcare claims processing, recovery, refunds, and/or appeals
• Experience with claims accounting, financial reconciliation, or financial reporting
• Familiarity with Blue Cross Blue Shield plans, CMS, or other highly regulated healthcare environments
• Experience leading high-volume claims operations teams, including team leads or people managers
• Demonstrated success with process improvement, operational efficiency, and claims quality initiatives

What You’ll Get

• The opportunity to work at thecutting edgeof health care delivery with a teamthat’sdeeply invested in the community
• Work-life balance, flexibility, and the autonomy to dogreat work
• Medical, dental, and vision coverage along withnumeroushealth and wellness programs
• Parental leave and support plus adoption and surrogacyassistance
• Career development programs and tuition reimbursement for continued education
• 401k match including an annual company contribution
• Learn more

Where You’ll Work

Our Hybrid Flex approach is built on presence with a purpose - giving you flexibility to work remotely with intentional in-person connection - that supports a workplace that’s flexible, connected, and future focused.

In a Hybrid-Flex role, you’ll work in the office at least two days a week for collaboration and connection. In a Remote Flex role, you’ll work virtually, with a few in-office visits each year for meaningful moments that matter.

Whether your role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any states listed on this job posting. Onsite expectations will be discussed during the interview process.

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

• Based on annual corporate goal achievement and individual performance.

$107,901.00 - $172,642.00