Note: The job is a remote job and is open to candidates in USA. Blue Cross NC is a health insurance organization focused on health care delivery and community service. The Financial Claims Associate supports financial claims expense invoicing, reporting, analysis, reimbursement determination, forecasting, reconciliations, audits, and stop loss coverage activities. The role also researches claims and operational inquiries and supports quality reviews to enhance customer satisfaction.
Responsibilities
- 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
Skills
- 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
Benefits
- 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
- Hybrid Flex work arrangement with flexibility to work remotely and intentional in-person connection
- Remote Flex work arrangement with virtual work and a few in-office visits each year
Company Overview