Senior Claims Operations Leader

Blue Cross and Blue Shield of North Carolina; Charlotte (NC); 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 with company match

Job summary

Blue Cross and Blue Shield of North Carolina is seeking a Manager, Claims to lead end-to-end service for provider segments, drive financial processing and customer service excellence. You will oversee claims submission, refunds and recovery across lines of business and partner with claims leadership to meet contractual obligations.

The role emphasizes accounting accuracy, financial reporting and data-driven improvements, with oversight of staff and cross-functional collaboration to sustain high

Qualifications

• Bachelor's degree or advanced degree; 8+ years experience in related field, or 10+ years if no degree.
• 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.

Skills

Accounts Receivable

Claims Analysis

Claims Management

Claims Processing

Claims Resolution

Claims Submission

Documentation

Financial Processing

Health Insurance

Insurance Claim Handling

Insurance Claims Processing

Insurance Industry

Medicare Advantage

People Management

Recruiting

Education

Bachelor's degree or advanced degree

Job description

Blue Cross and Blue Shield of North Carolina is seeking a Manager, Claims to lead end-to-end service for provider segments, drive financial processing and customer service excellence. You will oversee claims submission, refunds and recovery across lines of business and partner with claims leadership to meet contractual obligations.

The role emphasizes accounting accuracy, financial reporting and data-driven improvements, with oversight of staff and cross-functional collaboration to sustain high