Lead Claims Bluecard Analyst

Role Overview

• 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.

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