BlueCard Program Coordinator

HMSA•Kapolei, HI

About The Position

This role is responsible for interpreting and implementing program guidance related to Inter-Plan Program policies and manuals, ensuring accountability for Inter-Plan governance and policy matters. The coordinator will manage and resolve complex inquiries regarding BlueCard claims for HMSA customers, utilizing various systems and tools for research. Key responsibilities include coordinating communication and decisions for Inter-Plan Programs, leading reporting efforts to ensure accurate claims processing and payment, and collaborating with multidisciplinary teams to influence senior decision-makers for project support. The role also involves acting as a Subject Matter Expert (SME), participating in workflow changes, identifying training needs, and completing corporate training and compliance initiatives.

Requirements

Bachelor's degree and four years of related work experience; or an equivalent combination of education and work experience
Excellent verbal and written communication skills
Project and process management skills, with the ability to handle multiple vendors and multiple contracts
Intermediate level knowledge of Microsoft Office applications, including Word, Outlook, Excel, and Power Point.

Responsibilities

Provide and interpret program guidance internally regarding Inter-Plan Program policies and manuals, ensuring accountability for all Inter-Plan governance and policy matters.
Monitor and manage inventory of unresolved complex inquiries to provide timely follow-up and accurate resolution of BlueCard claims for HMSA customers.
Use ITS, Blue2 systems, reference databases, applications, and other tools to research claims questions and inquiries.
Coordinate communication and decisions related to Inter-Plan Programs and other Inter-Plan functions.
Lead and distribute BCBSA communications to appropriate individuals within the Plan, working with various internal departments.
Coordinate payment for claims due to dual or more membership.
Lead and participate in reporting team requests to produce data and ensure BlueCard claims are being processed and paid accurately.
Compile reports about incidents, events, and updates regarding claims processing issues and conflicts, providing recommendations and resolutions.
Coordinate with multidisciplinary teams; present and influence senior decision makers to secure necessary resources and funding to support National and BCBS Association projects.
Apply advanced knowledge and service as the unit's SME.
Participate and lead meetings on workflow changes, identifying training needs, process improvements, and project implementations including vendor and internal areas.
Complete or participate in corporate training, compliance certification or initiatives as directed by upper management.
Perform all other miscellaneous responsibilities and duties as assigned or directed.