Senior Claims Operations Manager

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

Job summary

Blue Cross NC is seeking a Manager, Claims to lead end-to-end service across provider segments, delivering against targets in claims processing, refunds, and recovery across lines of business. The role sets performance targets and collaborates with claims leadership to ensure accurate accounting and financial reporting.

You will manage the accounting and financial reporting functions, oversee data gathering and reconciliation, and drive improvements with Audit and Payment Integrity to sustain

Qualifications

• Bachelor’s degree or advanced degree required; 8+ years of related experience if no degree.
• 8+ years of experience in a related field; in lieu of degree, 10+ years of experience.

Responsibilities

• Streamline shared processing to reduce management by exception.
• Set operational processes to address market trends and customer demand.
• Manage accounting and financial reporting functions in support of Finance.
• Research and resolve banking issues.
• Participate in projects to improve claims processing, recovery, and accounting.
• Oversee refunds and collections and ensure high utilization and engagement.
• Lead team leads and staff to drive work volume and performance.
• Resolve complex claims appeals with stakeholders for high value claims.
• Collaborate with Audit and Payment Integrity to maintain accuracy and quality.
• Design tools and processes to improve customer satisfaction.
• Negotiate performance guarantees and RFPS in collaboration with Sales.
• Serve as ASO Claims SME and single point of contact for monitoring and troubleshooting.
• Represent Claims Operations to ASO executives with data, reports, and analytics.

Skills

Claims Processing

Claims Management

Accounts Receivable

Financial Reporting

People Management

Data Analytics

Medicare Advantage

Insurance Industry

Billing & Collections

Leadership

Education

Bachelor’s degree or advanced degree

Job description

Blue Cross NC is seeking a Manager, Claims to lead end-to-end service across provider segments, delivering against targets in claims processing, refunds, and recovery across lines of business. The role sets performance targets and collaborates with claims leadership to ensure accurate accounting and financial reporting.

You will manage the accounting and financial reporting functions, oversee data gathering and reconciliation, and drive improvements with Audit and Payment Integrity to sustain