Supervisor - Claims Systems

BCBS Global Solutions; King of Prussia (PA); Hybrid; USD 110,000 - 140,000; Full time

Benefits offered by this job

Annual bonus

Medical plans

Telemedicine

Parental leave

Well-being program

Global coverage

Work abroad

PTO carryover

Job summary

Blue Cross Blue Shield Global Solutions seeks a Supervisor, Claims Systems to lead daily operations, configure systems, and ensure compliant, efficient claims processing. This hybrid role requires coordinating with IT, Product, Enrollment, and Finance while guiding a team of analysts.

You will drive system builds, testing, and UAT, translating business needs into technical specs and ensuring alignment across enrollment and adjudication logic.

Qualifications

• 1+ years of leadership experience.
• 2+ years in claims operations or related healthcare/insurance domain.
• Experience with claims platforms (Actisure, Guidewire) and system configurations.
• Experience translating business requirements into system specifications.
• Proficiency in data analysis tools (Excel, SQL).

Responsibilities

• Oversee daily operation and performance of claims administration systems.
• Configure and maintain system settings including benefit plans, provider setup, code sets, and user roles.
• Monitor system functionality and address issues impacting accuracy and compliance.
• Lead and execute user acceptance testing (UAT) and defect resolution.
• Collaborate with IT, Product, Enrollment, Finance, Compliance, and vendors on enhancements and upgrades.
• Supervise a team of claims system analysts and manage workload.

Skills

Leadership

Claims operations

Claims systems

Systems analysis

Data analysis

Tools

Actisure

Guidewire

SQL

Job description

Who We Are.

At Blue Cross Blue Shield Global Solutions SM (BCBS Global Solutions SM ), we make it easy for people and organizations to access and pay for healthcare abroad. By combining digital innovation with human-centered care, we go above and beyond for our customers and deliver an international healthcare experience that’s simple, efficient, and human.

Who We Are.

At Blue Cross Blue Shield Global Solutions SM (BCBS Global Solutions SM ), we make it easy for people and organizations to access and pay for healthcare abroad. By combining digital innovation with human-centered care, we go above and beyond for our customers and deliver an international healthcare experience that’s simple, efficient, and human.
Whether our customers live, work, travel or study abroad, we give them the confidence and peace of mind to embrace every journey and say “yes” to new possibilities.
The Supervisor, Claims Systems is a hybrid leadership and hands-on role responsible for the day-to-day operation, support, and continuous improvement of claims administration systems. This position combines direct oversight of a team with active involvement in system configuration, issue resolution, and implementation activities. The role ensures claims systems operate accurately, efficiently, and in compliance with business and regulatory requirements, while also contributing directly to key system initiatives and operational deliverables.

Responsibilities:

Claims Systems Oversight & Hands-On Support

• Oversee daily operation and performance of claims administration systems, including Actisure and related platforms
• Perform hands-on system configuration and maintenance, including benefit plans, provider setup, code sets, user roles, permissions, and claims correspondence
• Monitor system functionality and directly address issues impacting claims processing accuracy, timeliness, and compliance
• Maintain system controls and ensure adherence to operational standards

Operational Change & Product Enablement

• Translate business and operational changes (e.g., new products, benefit updates, enrollment changes, regulatory requirements) into system requirements
• Configure, review, and validate system updates to ensure accuracy prior to release
• Participate directly in system build, testing, and validation activities
• Ensure alignment between Enrollment and Claims for eligibility, benefits, and adjudication logic
• Collaborate with IT, Product, Enrollment, Finance, Compliance, and vendors on system enhancements, upgrades, integrations, and defect resolution
• Lead and execute user acceptance testing (UAT), including test planning, scripting, execution, and defect resolution and support implementation readiness and perform post-release validation activities
• Serve as a primary point of contact for Claims Systems-related questions, issues, and initiatives.

Risk Management, Compliance & Controls

• Ensure claims systems and configurations comply with regulatory requirements, contractual obligations, and internal policies
• Participate in and support audits (e.g., SOC and other internal/external audits), including documentation, testing, and remediation
• Monitor system performance and operational trends; take direct action to resolve risks and control gaps.

People Leadership & Work Execution

• Supervise and support a team of claims system analysts while also carrying an individual workload
• Assign and prioritize teamwork alongside personal responsibilities to ensure timely delivery of system updates and issue resolution
• Provide coaching, guidance, and feedback while reinforcing accountability and quality of work
• Step in to perform analyst-level work as needed to support team capacity and critical initiatives

Requirements:

• 1+ years of leadership experience
• 2+ years of experience in claims operations, claims systems, or business systems analysis within healthcare or insurance
• Experience working with claims administration platforms (e.g., Actisure, Guidewire, or similar systems)
• Experience supporting system implementations, enhancements, and testing activities
• Strong understanding of claims processing workflows and system configurations
• Experience translating business requirements into system specifications
• Proficiency in data analysis and reporting (e.g., Excel, SQL, or similar tools preferred)
• Familiarity with system testing methodologies (UAT, regression testing)
• Ability to translate business and product requirements into operational system solutions.
• Knowledge of claims lifecycle, benefit structures, and eligibility processes
• Understanding of regulatory and compliance requirements impacting claims processing
• Exposure to payment integrity and reconciliation processes preferred

What you’ll get in return:

• Competitive base pay + annual bonus
• Competitive medical plans
• Telemedicine available
• Paid parental leave
• Employee assistance and wellness support 24/7
• Free international healthcare coverage

Other Great Perks:

• Work abroad arrangements available
• Generous PTO accrual program with carry-over option
• 9 paid holidays in addition to one floating holiday and one volunteer day
• Tuition reimbursement
• Career/Learning and development opportunities
• 401(k) with generous company match
• Pet insurance offerings
• Identity theft and legal coverages available
• Emphasis on well-being (Virtual well-being platform, monthly mindfulness events, and giveaways)