Senior Claims Operations & Finance Manager

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

Benefits offered by this job

Medical, dental, and vision coverage

Parental leave and adoption support

401k match

Tuition reimbursement

Career development programs

Annual incentive bonus

Job summary

Blue Cross NC is seeking a Manager, Claims to lead end-to-end service across provider segments, driving performance targets and efficient claims processing. You will oversee claims submission, refunds, and recovery, while collaborating with leadership on contractual obligations and financial reporting.

The role requires extensive experience in claims operations, analytics, and leadership, with a focus on accuracy, process improvement, and customer satisfaction within a regulated health insurance

Qualifications

• Bachelor's degree or advanced degree required or 10+ years of related experience in lieu of degree.
• 8+ 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.

Skills

Accounts Receivable (AR)

Claims Analysis

Claims Management

Claims Processing

Claims Resolution

Claims Submission

Documentations

Financial Processing

Health Insurance

Insurance Claim Handling

Insurance Claims Processing

Insurance Industry

Medicare Advantage

People Management

Recruiting

Education

Bachelor's degree or advanced degree

Tools

Facets

Job description

Blue Cross NC is seeking a Manager, Claims to lead end-to-end service across provider segments, driving performance targets and efficient claims processing. You will oversee claims submission, refunds, and recovery, while collaborating with leadership on contractual obligations and financial reporting.

The role requires extensive experience in claims operations, analytics, and leadership, with a focus on accuracy, process improvement, and customer satisfaction within a regulated health insurance