FEP Manager, Claims

Blue Cross and Blue Shield of North Carolina; North Carolina; Hybrid; USD 108,000 - 173,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

401k match

Paid Time Off

Job summary

Blue Cross NC is seeking a seasoned FEP Manager, Claims to lead end-to-end claims operations across provider segments and deliver against business targets. You’ll drive processing, refunds, and recovery, while ensuring accurate financial reporting and strong customer service.

The role requires 8+ years in related fields and a Bachelor’s degree (or 10+ years of experience in lieu of degree). Hybrid work from Durham area with national remote options available.

Qualifications

• 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.

Responsibilities

• Streamline shared processing to reduce management by exception.
• Set operational process to address market trends, BCBSNC capabilities and customer demand.
• Oversee accounting and financial reporting functions, ensuring compliance with accounting principles and standards.
• Research and resolve banking issues.
• Participate in projects to improve claims processing, recovery, and accounting functions.
• Manage financial recovery activities including refunds and collections.
• Lead team leads and staff 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 and procedural changes to improve customer satisfaction.
• Negotiate Claims ASO performance guarantees, reviews, approvals, and client RFPS with Sales.
• Represent FEP Claims Operations as SME and single point of contact for escalations.

Skills

Claims processing

Financial reporting

Team leadership

Process improvement

Stakeholder collaboration

Education

Bachelor's degree or advanced degree

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

Job description

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 the cutting edge of health care delivery with a team that’s deeply invested in the community
• Work-life balance, flexibility, and the autonomy to do great work
• Medical, dental, and vision coverage along with numerous health and wellness programs
• Parental leave and support plus adoption and surrogacy assistance
• 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

About Us

It’s an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we’re leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care – in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians. Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all. Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.

Authorization to Work in the United States

We use E-verify to confirm authorization to work in the United States. To learn more about E-Verify, including your rights and responsibilities, please visit E-Verify Overview for English or Visión General de E-Verify for Español.

Request Accommodations

Blue Cross NC provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application, hiring process, or have technical issues that prevent you from completing your application please notify HR at [e-mail].

Blue Cross NC is a Hybrid Flex company. Whether the 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 of our approved states: Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming