Healthcare Management Administrators

Healthcare Management Administrators is a specialized third-party administrator that provides high-quality, innovative, and affordable health plans for self-funded employers, emphasizing exceptional service and a collaborative partnership model.

Insurance

Financials

251-1K (270)

Founded 1986

3 open positions

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Claims Bluecard Analyst IV, Lead

7 hours, 10 minutes ago

United States

Full-time

Lead

Operations Analyst

Data Science and Analytics

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Healthcare Management Administrators

Insurance

251-1K

Founded 1986

View All Jobs 3

Description

Monitor BlueWeb for Association updates and assess impacts to claims, pricing, and training.
Track provider terminations and coordinate continuity-of-care and disruption analysis.
Serve as a subject matter expert on BlueCard/ITS claims processing rules and program requirements.
Coach team members on BlueCard/ITS guidelines, updates, and operational changes.
Coordinate Association projects and rule interpretation with Regence and InterPlan stakeholders.
Act as a key escalation point for Plan-to-Plan and other complex claims issues.
Oversee complex ITS/BlueCard workflows and lead system and pricing enhancement projects.
Test and validate system updates and refine related policies and procedures.
Perform root-cause analysis on recurring issues and implement process improvements.
Monitor InterPlan performance, quality, and productivity metrics and lead improvement initiatives.
Oversee daily ITS claims workflows to ensure timely, accurate adjudication across claim types.
Partner with leadership and external plans to resolve sensitive or high-impact claim issues.

Requirements

High school diploma required; Associate’s degree preferred.
5-7+ years of claims processing experience in 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.
Experience with BlueCard/ITS claims processing in a preferred or highly qualified candidate context.

Benefits

Base salary of $47.89/hr - $55.76/hr in the greater Seattle area, with pay varying by geography, skills, experience, and education.
17 days of paid time off for individual contributors, plus 11 paid holidays.
Two paid personal days and one paid volunteer day.
Company-subsidized medical, dental, vision, and prescription insurance.
Company-paid disability, life, and AD&D insurance, plus voluntary insurance options.
401(k) retirement plan with company match.
Annual $500 wellness incentive and $600 wellness reimbursement.
Remote work options and continuing education reimbursements.
Parental leave and up to $1,000 annual charitable giving match.
Flexible schedules, free parking, gym access, refreshments, and regular in-person team events.

Interested in this position?

Apply directly on the company website

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