Claims Bluecard Analyst IV, Lead

About the role

HMA is the premier third-party health plan administrator across the PNW and beyond. We deliver customized health plans to medium to large-size employers, offering high-quality, affordable healthcare options supported by best-in-class customer service.

Responsibilities

• Ensure accurate, compliant adjudication across complex BlueCard claims
• Translate BlueWeb and Association changes into operational action
• Partner closely with Regence and InterPlan stakeholders
• Monitor and improve IPP (InterPlan Program) performance
• Serve as an enterprise escalation point
• Lead cross-functional initiatives
• Drive training, quality, and process improvements
• Coordinate Association projects and rule interpretation with Regence and InterPlan executives
• Act as key escalation point for Plan-to-Plan issues
• Cascade InterPlan communications to internal teams
• Operational Change Leadership
• Oversee complex ITS/BlueCard workflows
• Lead system and pricing enhancement projects
• Test and validate system updates
• Rewrite ITS/BlueCard policies and procedures
• Conduct root-cause analysis on recurring issues and implement improvements
• Claims Adjudication
• Oversee daily ITS claims workflows
• Ensure timely, accurate adjudication across all claim types
• Partner with leadership to refine ITS policies
• Support operational strategy
• Act as a liaison with BCBS host/home plans and external partners
• Partner with leadership to refine ITS policies
• Support operational strategy
• Act as a liaison with BCBS host/home plans and external partners

Requirements

• High school diploma required, Associate's Degree preferred
• 5-7+ years of claims processing experience within 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

Qualifications

• Knowledge of BlueCard/ITS claims processing rules and operational program requirements
• Ability to coach team members on guidelines and changes
• Experience with InterPlan Program (IPP)
• Ability to monitor and communicate InterPlan performance metrics
• Ability to track quality and productivity metrics
• Ability to lead improvement initiatives

Skills

• Excellent communication and collaboration skills
• Strong problem-solving and analytical skills
• Proficiency in Microsoft Office, particularly Excel
• Understanding of healthcare regulations and compliance
• Ability to work independently and as part of a team

Benefits

Compensation: The base salary range for this position in the greater Seattle area is $47.89/hr - $55.76/hr for a level IV and varies dependent on geography, skills, experience, education, and other job or market-related factors. While we are looking for level I, we may consider level II for highly qualified candidates.

Benefits include:

• Seventeen (IC) days paid time off (individual contributors)
• Eleven paid holidays
• Two paid personal and one paid volunteer day
• Company-subsidized medical, dental, vision, and prescription insurance
• Company-paid disability, life, and AD&D insurances
• Voluntary insurances
• HSA and FSA pre-tax programs
• 401(k)-retirement plan with company match
• Annual $500 wellness incentive and a $600 wellness reimbursement
• Remote work and continuing education reimbursements
• Discount program
• Parental leave
• Up to $1,000 annual charitable giving match

Pay

The base salary range for this position in the greater Seattle area is $47.89/hr - $55.76/hr for a level IV and varies dependent on geography, skills, experience, education, and other job or market-related factors. While we are looking for level I, we may consider level II for highly qualified candidates.

Schedule

Flexible schedule available to support people in all time zones across the US, ensuring a healthy work-life balance.