Proving What's Possible in Healthcare®
Lead Claims Bluecard Analyst
Location
Washington
Posted
5 days ago
Salary
$47 - $55 / hour
Seniority
Senior
Job Description
Lead Claims Bluecard Analyst
Healthcare Management Administrators
• Monitor BlueWeb for Association updates and analyze release notes to determine claim, pricing, and training impacts. • Track provider terminations and communicate impacts; coordinate continuity-of-care and disruption analysis. • Serve as SME on BlueCard/ITS claims processing rules and operational program requirements. Coach team members accordingly on guidelines and changes. • Coordinate Association projects and rule interpretation with Regence and InterPlan Executives. • Act as key escalation point for Plan-to-Plan issues. • Cascade InterPlan communications to internal teams. • Oversee complex ITS/BlueCard workflows; lead system and pricing enhancement projects. • Test and validate system updates; refine ITS/BlueCard policies and procedures. • Conduct root-cause analysis on recurring issues and implement improvements. • Monitor and communicate InterPlan performance metrics (IPP). • Track quality and productivity metrics; lead improvement initiatives. • Oversee daily ITS claims workflows and ensure timely, accurate adjudication across all claim types. • Serve as the primary escalation point for the most complex, sensitive, or high-impact ITS/BlueCard claim issues. • Partner with leadership to refine ITS policies, update procedures, and support operational strategy. • Act as a liaison with BCBS host/home plans and external partners for escalated claim issues.
Job Requirements
- High school diploma required, Associate’s Degree preferred
- 5-7+ years of claims processing experience within the insurance industry
- 3-5 years of BCBS claims processing experience
- 1+ years of proven leadership experience
- Expert Excel skills with the ability to manipulate data independently
- Expert-level understanding of ITS/BlueCard processing, pricing methodologies, and BCBS national programs.
- Strong leadership, communication, and coaching abilities.
- Ability to manage competing priorities and support team performance.
- High-level analytical skills with the ability to interpret data and drive improvements.
Benefits
- Seventeen (IC) days paid time off (individual contributors)
- Eleven paid holidays
- Two paid personal and one paid volunteer day
- Company-subsidized medical, dental, vision, and prescription insurance
- Company-paid disability, life, and AD&D insurances
- Voluntary insurances
- HSA and FSA pre-tax programs
- 401(k)-retirement plan with company match
- Annual $500 wellness incentive and a $600 wellness reimbursement
- Remote work and continuing education reimbursements
- Discount program
- Parental leave
- Up to $1,000 annual charitable giving match
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