Job Description
Responsible for financial claims expense invoicing, reporting, analysis and forecasting. Prepares financial claims expense invoices, reports and operating trends. Prepares financial claims expense statements through the coordination of the month end close and reporting process as well as applicable analysis and accounting research. Research and analysis could include root cause analysis, resolution of inquiries and/or activities, which may include claims, plan policies, products, rates, membership, enrollment, underwriting, direct sales, contract and/or program engagement to support finance and/or business operation. Responsible for developing, utilizing, interpreting, and/or reporting claims expense financial data as it relates to historical claims expense reporting, forecasting and/or estimating the future trends in health care costs
What You'll Do
- Develop, analyze, interpret, report, and present historical and/or forecasted financial claims expense and stop loss coverage information.
- Prepare claims expense financials, estimated claim expense and financial forecasts. Prepare financial and business-related analysis and research.
- Coordinate and direct the preparation of stop loss coverage for employer groups or stop loss vendors based on actual high dollar claims and/or claimants’ performance, previous stop loss credits, estimated claims expense, expense reports and other factors.
- Prepare reports and analysis for various audiences such as Self-Funded Groups (Employer), Stop Loss Vendors, Sales, Underwriting, etc. Responsible for monthly variance analysis (at employer group level or consolidated company level).
- Act as a consultant for management on financial policy, procedure and application as well as historical, plan and forecasting.
- Review and check for accuracy of various internal and external reports, such as membership, commissions, and the impact of large claims on the administrative services and stop loss coverage for use in financial analysis.
- Prepare employer group transactions and Statement of account reconciliations, assist with the monthly, run out and final close out activities, prepare schedules and other general accounting functions.
- Process a variety of client transactions that may include suspended and/or hold of claims, Run out administrative fees, and/or employer group settlement.
- Determine benefit eligibility for stop loss coverage on claims for specific claimants based on contract terms. Includes a variety of stop loss vendor transactions such as inquiries regarding utilization, provider information, medical reviews, Leave of absence language, COBRA benefits, and plan documentation.
- Act as a point of contact for internal and/or external audits and projects as necessary; assist in planning, scoping, testing, training and implementation.
- Perform quality reviews of operational inquiries to determine the accuracy of information provided and ensure employees are functioning at the expected level of service to enhance customer satisfaction. Communicate the results of the reviews to improve individual and overall performance and make recommendations for coaching and training as necessary.
- Handle more complex problems of eligibility and documentation with producers. May provide additional information to underwriting staff when submitting referrals for exception consideration.
What You Have
- Bachelor's degree or advanced degree (where required)
- 3+ years of experience in related field
- In lieu of degree, 5+ years of experience in related field
Bonus Points
- Experience analyzing and interpreting data to support business decisions.
- Experience presenting information to clients, customers, or business stakeholders.
- Proficiency with Microsoft Excel and other data analysis tools.
- Strong written and verbal communication skills.
- Demonstrated ability to manage multiple priorities and deadlines simultaneously.
- Background working with healthcare, insurance, claims, or benefits-related data.
- Proven experience with stop-loss coverage concepts preferred.
- Experience supporting external clients or customer-facing business functions.
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 including an annual company contribution
Where You’ll Work
Our Hybrid-Flex approach is built on presence with a purpose – giving you flexibility to work remotely with intentional in-person connection – that supports a workplace that’s flexible, connected, and future focused.
In a Hybrid-Flex role, you’ll work in the office at least two days a week for collaboration and connection. In a Remote-Flex role, you’ll work virtually, with a few in-office visits each year for meaningful moments that matter.
Whether your role is Hybrid-Flex or Remote-Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any states listed on this job posting. Onsite expectations will be discussed during the interview process.
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.
$60,907.00 - $97,452.00
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.
