Senior BlueCard/ITS Claims Lead

Healthcare Management Administrators; Washington (Washington County); On-site; USD 65,973 - 76,814; Full time

Benefits offered by this job

Remote work options

401(k) retirement plan with company  +

Wellness incentive

Education reimbursement

Paid time off

Job summary

Healthcare Management Administrators (HMA) seeks a BlueCard/ITS Claims Specialist to ensure accurate adjudication across complex BlueCard claims. You will translate BlueWeb/Association changes into action, partner with Regence and InterPlan stakeholders, and drive performance improvements while supporting frontline teams.

The role requires 5–7+ years in claims processing, BCBS experience, and strong Excel skills.

Qualifications

• High school diploma required; Associate’s Degree preferred
• 5-7+ years of claims processing experience within the insurance industry
• 3-5 years of BCBS claims processing experience
• 1+ years of proven leadership experience
• Expert Excel skills with the ability to manipulate data independently
• Expert-level understanding of ITS/BlueCard processing, pricing methodologies, and BCBS national programs
• Strong leadership, communication, and coaching abilities
• Ability to manage competing priorities and support team performance
• High-level analytical skills with the ability to interpret data and drive improvements

Responsibilities

• BlueWeb Review: Monitor BlueWeb for Association updates and analyze release notes to determine claim, pricing, and training impacts
• Track provider terminations and communicate impacts; coordinate continuity-of-care and disruption analysis
• Serve as SME on BlueCard/ITS claims processing rules and operational program requirements. Coach team members accordingly on guidelines and changes
• Coordinate Association projects and rule interpretation with Regence and InterPlan Executives
• Act as key escalation point for Plan-to-Plan issues
• Cascade InterPlan communications to internal teams
• Oversee complex ITS/BlueCard workflows; lead system and pricing enhancement projects
• Test and validate system updates; refine ITS/BlueCard policies and procedures
• Conduct root-cause analysis on recurring issues and implement improvements
• Monitor and communicate InterPlan performance metrics (IPP)
• Track quality and productivity metrics; lead improvement initiatives
• Oversee daily ITS claims workflows and ensure timely, accurate adjudication across all claim types
• Serve as the primary escalation point for the most complex, sensitive, or high‑impact ITS/BlueCard claim issues
• Partner with leadership to refine ITS policies, update procedures, and support operational strategy
• Act as a liaison with BCBS host/home plans and external partners for escalated claim issues

Skills

Claims processing

BCBS knowledge

Leadership

Excel expertise

Data analysis

Education

High school diploma

Associate's Degree preferred

Tools

Excel

Job description

Healthcare Management Administrators (HMA) seeks a BlueCard/ITS Claims Specialist to ensure accurate adjudication across complex BlueCard claims. You will translate BlueWeb/Association changes into action, partner with Regence and InterPlan stakeholders, and drive performance improvements while supporting frontline teams.

The role requires 5–7+ years in claims processing, BCBS experience, and strong Excel skills.