Manager, Claims Operations & Financials

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

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

401k match

PTO

Tuition reimbursement

Parental leave

Job summary

Blue Cross NC in North Carolina seeks a Manager, Claims to lead end-to-end service models across provider segments and ensure delivery against business targets. You will oversee claims processing, refunds, and recovery, collaborating with leadership on contractual obligations and financial reporting.

The role requires strategic operation setup, staff management, and cross-functional coordination to improve accuracy and customer satisfaction while driving performance metrics and compliance.

Qualifications

• 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.

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
• Serve as ASO Claims Subject Matter Expert and single point of contact for performance monitoring and troubleshooting.
• Represent Claims Operations to ASO executives providing data, reports, analytics, and expertise routinely and on demand.
• Support ASO Channel lead serving as the Claims ASO Subject Matter Expert and acting as single point of contact both internally and to the ASO for all Claims, Claims Recovery, and Claims Accounting related escalations.

Education

Bachelor's degree or advanced degree

Job description

Blue Cross NC in North Carolina seeks a Manager, Claims to lead end-to-end service models across provider segments and ensure delivery against business targets. You will oversee claims processing, refunds, and recovery, collaborating with leadership on contractual obligations and financial reporting.

The role requires strategic operation setup, staff management, and cross-functional coordination to improve accuracy and customer satisfaction while driving performance metrics and compliance.