Job Details

Job Description

We're seeking an Interplan Service Specialist to join our team. The Interplan Specialist resolves any issue, whether common, complex and/or escalated, directly impacting provider and member claims by working with internal partners, other BCBS Health Care Plans, our members, groups and providers. The Specialist will work independently to resolve issues and remove obstacles to timely issue resolution, and, when needed, partner with other areas of the company. Resolution efforts must comply with: internal policies, including Compliance; Blue Cross Blue Shield Association (BCBSA) and partner plan servicing requirements; BCBSA Interplan Scorecard timeliness metrics; NC DOI regulations; CMS regulations; and state and federal law.

What You'll Do

• Act as a service relationship professional, handling incoming telephonic or electronic partner plan inquiries from beginning to completion to meet performance metrics and improve overall member/provider satisfaction with the Blue Card Program.
• Triage and resolve customer inquiries on first contact whenever possible. Document corrective measures and provide instructions or outcomes to member, group or provider customers as needed, as well as to internal business areas to ensure prompt resolution of and response to Interplan inquiries.
• Serve as a Subject matter expert on Inter-Plan business across all lines of business, including SMA.
• Identify problems, gaps, or inconsistencies in workflows, and/or processes; recommend updates, alternatives and/or solutions.
• Review and research incoming healthcare claims from providers (doctors, clinics, etc) by navigating multiple computer systems and platforms and verifies the data/information necessary for processing (e.g. pricing, prior authorizations, applying benefits)
• Recognize patterns of inconsistent and/or inaccurate claims filing practices among customers and providers, educate customers and providers on acceptable BCBSNC practices and policies
• Provide coaching and feedback to individuals in other departments regarding claims, claims errors, and other related activities (keying claims, appeals, medical records, etc)
• Identify, fix, and eliminate operational issues that are identified as trends/patterns of untimely, inaccurate, non-compliant, or inconsistent claims adjudication or messaging for our participating providers or partner BCBS Health Care Plans involving multiple systems and inquiry platforms.
• Act as a point of contact for internal and/or external audits and projects as necessary; assists in planning, scoping, testing, training and implementation.
• Handle special projects as necessary; creates and reports on project data analysis. May be asked to present IPP specific information to internal partners, including large groups or teams.

• Identify, fix, and eliminate operational issues that are identified as trends/patterns of untimely, inaccurate, non-compliant, or inconsistent claims adjudication for our participating providers or partner BCBS Health Care Plans involving multiple systems and inquiry platforms.
• Develops and maintains assigned reports as required.

What You Bring

• High school diploma or GED
• 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

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.

$41,600.00 - $66,561.00

Skills

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