Manager BlueCard Claims

Position Description

Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more.At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.” 

This position has oversight of all aspects of BlueCard Home and Host Claims Operations and may function as a liaison between the Blue Cross and Blue Shield Association and Capital Blue Cross. On-going collaboration with other Plans and internal areas that impact performance is essential to identify opportunities to increase efficiency, resolve problematic issues and mitigate risk. Developing a good rapport and productive relationship with other Plans and contacts at the Blue Cross Blue Shield Association is essential as a secondary aspect of this position is to function as back-up Inter-Plan Executive to the Director, National Programs. Understanding of BCBSA policies, projects, workgroups, enhancements, and Inter Plan issues is a key aspect of this role in supporting Capital Blue Cross.

Responsibilities and Qualifications

• Oversight of BlueCard Home and Host Claims Operations with engaged inventory management to ensure achievement of Capital Blue Cross Transactional Index measures.
• Knowledge and oversight accountability of Blue Cross and Blue Shield Association Policies and Procedures to ensure compliance within Operations and other internal impact areas.
• Knowledge and oversight of the Inter Plan Performance Scorecard measures. This requires on-going collaboration primarily with Operations, Clinical, Corporate Performance, FBS & IT.
• Prepare monthly & quarterly Performance Reports with explanations and action plans for the performance measures identified as opportunities for improvement.
• Monitor and assist the Operations areas to resolve or escalate individual or large-scale issues unable to be resolved through the normal Operations procedures.
• Actively participate in BCBSA BlueCard Workgroups and Projects as assigned.
• Attend a potential of two BCBSA in person collaborative meetings with other Plan’s to identify best practices that may prove of value to Capital Blue Cross, resolve individual or multiple Plan issues and establish a network of contacts from other Plans.
• It is also critical to be engaged with BlueCard system releases on an annual basis to comply with the certification of the project milestones, understand the enhancements associated with the new functionality and how the changes may improve our corporate delivery of the Program.
• Likewise, it is critical to remain engaged in National Programs webinars and understand BCBSA projects and initiatives to remain an educated resource, assess potential impacts, keep sight of project timelines as applicable, monitor installation of any procedure/system changes and ensure any required communications are generated in accordance with Capital Blue Cross policy.

Skills:

• Demonstrated ability to develop, coordinate, manage, guide, and consult with various internal and external personnel for major National projects that have a multi-divisional and/or corporate impact.
• Demonstrated ability to lead meetings and prepare and present written and oral material.
• Demonstrated analytical ability to resolve problematic issues, assess overall impact, recommend, and implement solutions.
• Demonstrated ability to work independently with minimal supervision. Includes ability to act both independently and as part of a project team as well as the ability to adapt to changing priorities.
• Ability to build productive Inter Plan Relationships

Knowledge:

• This position requires knowledge of Plan Profiles, the ITS system functionality with multiple transaction records and the reconciliation process via the Central Finance Agency.
• Knowledge of BlueCard Program Delivery, BlueCard Performance Measures & release concepts preferred.
• Knowledge of National Accounts and BCBSA policies & procedures preferred.
• Must have a detailed knowledge of the organization, business environment, and the health care industry, with an emphasis on National Accounts and the dynamics of Blue Cross and Blue Shield relationships.

Experience:

• 5 years related experience.
• 1 year staff, team lead or project lead experience.

Education and Certifications:

• Bachelor’s degree in business administration preferred.

Location: 

• This position is classified hybrid, which requires onsite work on Tuesdays and Wednesdays. 

Physical Demands:

• The working environment includes typical office conditions.

Other:

• This position may require travel to two in person BCBSA meetings on an annual basis.

 

About Us

We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues, and be encouraged to volunteer in your community.  We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.