Job Description

Responsible for financial claims expense invoicing, reporting, analysis, determining reimbursement and forecasting including the preparation of financial claims expense, weekly invoicing and statements through the month end closing. Delivers reporting and trends as well as research regarding administrative services and stop loss coverage. 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.

What You’ll Do

• Assist in the development, analysis, interpretation, invoicing, reporting, and presentation of historical and/or forecasted financial claims expense and stop loss coverage information.
  • Support preparation of invoicing and financial claims expense forecasts.
  • Support preparation of financials for 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 trend, expense reports and other factors.
  • Support the review of expenditures of employer groups’ subgroups to ensure conformance to Administrative Agreement.
• Support the preparation of reports and analysis for various audiences such as Self-Funded Groups (Employer), Stop Loss Vendors, Sales, Underwriting, etc. Support the monthly variance analysis (at employer group level or consolidated company level).
• Verification and identification of manual transaction fees/ contractual adjustments
• Preparation of any estimates and adjustments that may be needed for new or existing business.
• Prepare Statement of account reconciliations, assist with the monthly run out and final close out activities, prepare schedules, etc.
• Assist with compilation of data for internal/external audit
• Process a variety of client transactions that may include suspend 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.
• Assist with 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.

What You Bring  

• Bachelor's degree or advanced degree (where required)
• 0-2 years of experience in related field
• In lieu of degree, 3+ years of experience in related field

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  

• Learn more  

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.

$50,337.00 - $80,539.00

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.

About Us

It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians.

Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all.

Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.

Authorization to Work in the United States

We use E-verify to confirm authorization to work in the United States. To learn more about E-Verify, including your rights and responsibilities, please visit E-Verify Overview for English or Visión General de E-Verify for Español.

Request Accommodations

Blue Cross NC provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application, hiring process, or have technical issues that prevent you from completing your application please notify HR at HR.Staffing@bcbsnc.com.

Blue Cross NC is a Hybrid Flex company. Whether the 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 of our approved states:

Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming