Key Facts

Remote From:

Full time

Mid-level (2-5 years)

English

Hard Skills

Regulatory Compliance Claims And Litigation Management Medical Insurance Claims Data Validation Auditing Benefits Administration Process Improvement Project Status Reports Employee Coaching Communications Systems Stakeholder Communications Internal Documentation Help Desk Support

Other Skills

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Data Reporting
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Communication
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Teamwork
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Time Management
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Customer Service
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Analytical Thinking
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Detail Oriented
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Problem Solving

Roles & Responsibilities

High school diploma or GED
3+ years of experience in a related field
Experience handling healthcare claims, provider inquiries, or interplan servicing
Strong ability to work independently and adhere to internal policies, BCBSA and partner plan servicing requirements, BCBSA Interplan Scorecard metrics, NC DOI and CMS regulations, and state and federal law

Requirements:

Act as a service relationship professional handling incoming telephonic or electronic partner plan inquiries from start to finish to meet performance metrics and improve member/provider satisfaction with the Blue Card Program.
Triage and resolve customer inquiries on first contact whenever possible; document corrective measures and provide instructions or outcomes to members, groups, or providers and internal teams to ensure prompt resolution.
Serve as a subject matter expert on Inter-Plan business across all lines of business; identify problems or gaps in workflows and processes, and recommend updates, alternatives or solutions.
Review and research incoming healthcare claims from providers by navigating multiple systems to verify data necessary for processing (pricing, prior authorizations, applying benefits); identify patterns of inaccuracies and educate customers/providers; support audits and special projects as needed.

Blue Cross NC

Insurance

About Blue Cross NC

It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians. Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We employ more than 5,000 people who are passionate about health care, and we serve more than 4.3 million members. Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives. Blue Cross NC is an independent licensee of the Blue Cross and Blue Shield Association.

Company type: XLarge

Industry: Insurance

Founded: 2018

Company size: 5001 - 10000

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Job description

Job Description

We're seeking an Interplan Service Specialist to join our team. The Interplan Specialist resolves any issue, whether common, complex and/or escalated, directly impacting provider and member claims by working with internal partners, other BCBS Health Care Plans, our members, groups and providers. The Specialist will work independently to resolve issues and remove obstacles to timely issue resolution, and, when needed, partner with other areas of the company. Resolution efforts must comply with: internal policies, including Compliance; Blue Cross Blue Shield Association (BCBSA) and partner plan servicing requirements; BCBSA Interplan Scorecard timeliness metrics; NC DOI regulations; CMS regulations; and state and federal law.

What You'll Do

Act as a service relationship professional, handling incoming telephonic or electronic partner plan inquiries from beginning to completion to meet performance metrics and improve overall member/provider satisfaction with the Blue Card Program.
Triage and resolve customer inquiries on first contact whenever possible. Document corrective measures and provide instructions or outcomes to member, group or provider customers as needed, as well as to internal business areas to ensure prompt resolution of and response to Interplan inquiries.
Serve as a Subject matter expert on Inter-Plan business across all lines of business, including SMA.
Identify problems, gaps, or inconsistencies in workflows, and/or processes; recommend updates, alternatives and/or solutions.
Review and research incoming healthcare claims from providers (doctors, clinics, etc) by navigating multiple computer systems and platforms and verifies the data/information necessary for processing (e.g. pricing, prior authorizations, applying benefits)
Recognize patterns of inconsistent and/or inaccurate claims filing practices among customers and providers, educate customers and providers on acceptable BCBSNC practices and policies
Provide coaching and feedback to individuals in other departments regarding claims, claims errors, and other related activities (keying claims, appeals, medical records, etc)
Identify, fix, and eliminate operational issues that are identified as trends/patterns of untimely, inaccurate, non-compliant, or inconsistent claims adjudication or messaging for our participating providers or partner BCBS Health Care Plans involving multiple systems and inquiry platforms.
Act as a point of contact for internal and/or external audits and projects as necessary; assists in planning, scoping, testing, training and implementation.
Handle special projects as necessary; creates and reports on project data analysis. May be asked to present IPP specific information to internal partners, including large groups or teams.

Identify, fix, and eliminate operational issues that are identified as trends/patterns of untimely, inaccurate, non-compliant, or inconsistent claims adjudication for our participating providers or partner BCBS Health Care Plans involving multiple systems and inquiry platforms.
Develops and maintains assigned reports as required.

What You Bring

High school diploma or GED
3+ years of experience in related field.

What You’ll Get

The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community
Work-life balance, flexibility, and the autonomy to do great work
Medical, dental, and vision coverage along with numerous health and wellness programs
Parental leave and support plus adoption and surrogacy assistance
Career development programs and tuition reimbursement for continued education
401k match

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

*Based on annual corporate goal achievement and individual performance.

$41,600.00 - $66,561.00

Skills

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JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC. If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: HR.Staffing@BCBSNC.com.