Claims Bluecard Analyst IV, Lead

Healthcare Management Administrators•Washington, DC

2d•$48 - $56•Hybrid

About The Position

HMA is the premier third-party health plan administrator across the PNW and beyond. We relentlessly deliver on our promise to provide medium to large-size employers with customized health plans. We offer various high-quality, affordable healthcare plan options supported with best-in-class customer service. We are proud to say that for three years, HMA has been chosen as a ‘Washington’s Best Workplaces’ by our Staff and PSBJ™. Our vision, ‘Proving What’s Possible in Healthcare™,’ and our values, People First!, Be Extraordinary, Work Courageously, Own It, and Win Together, shape our culture, influence our decisions, and drive our results. What we are looking for: We are always searching for unique people to add to our team. We only hire people that care deeply about others, thrive in evolving environments, gain satisfaction from being part of a team, are motivated by tackling complex challenges, are courageous enough to share ideas, action-oriented, resilient, and results-driven. What you can expect: You can expect an inclusive, flexible, and fun culture, comprehensive salary, pay transparency, benefits, and time off package with plenty of personal development and growth opportunities. If you are looking for meaningful work, a clear purpose, high standards, work/life balance, and the ability to contribute to something important, find out more about us at: https://www.accesshma.com/ How YOU will make a Difference: As a BlueCard/ITS claims Specialist, this role ensures accurate, compliant adjudication across complex BlueCard claims, translates BlueWeb and Association changes into operational action, partners closely with Regence and InterPlan stakeholders, and monitors and improves IPP (InterPlan Program) performance. The Claims Specialist/BlueCard Hybrid serves as an enterprise escalation point, leads cross-functional initiatives, and drives training, quality, and process improvements that safeguard claim outcomes and member experience. What YOU will do: BlueWeb Review Monitor BlueWeb for Association updates and analyze release notes to determine claim, pricing, and training impacts. Track provider terminations and communicate impacts; coordinate continuity-of-care and disruption analysis. Serve as SME on BlueCard/ITS claims processing rules and operational program requirements. Coach team members accordingly on guidelines and changes. Collaboration with Regence 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; refine ITS/BlueCard policies and procedures. Conduct root-cause analysis on recurring issues and implement improvements. IPP Score Monitoring Monitor and communicate InterPlan performance metrics (IPP). Track quality and productivity metrics; lead improvement initiatives. Claims Adjudication Oversee daily ITS claims workflows and ensure timely, accurate adjudication across all claim types. Serve as the primary escalation point for the most complex, sensitive, or high‑impact ITS/BlueCard claim issues. Partner with leadership to refine ITS policies, update procedures, and support operational strategy Act as a liaison with BCBS host/home plans and external partners for escalated claim issues.

Requirements

High school diploma required
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.

Nice To Haves

Associate’s Degree preferred

Responsibilities

Monitor BlueWeb for Association updates and analyze release notes to determine claim, pricing, and training impacts.
Track provider terminations and communicate impacts; coordinate continuity-of-care and disruption analysis.
Serve as SME on BlueCard/ITS claims processing rules and operational program requirements. Coach team members accordingly on guidelines and changes.
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.
Oversee complex ITS/BlueCard workflows; lead system and pricing enhancement projects.
Test and validate system updates; refine ITS/BlueCard policies and procedures.
Conduct root-cause analysis on recurring issues and implement improvements.
Monitor and communicate InterPlan performance metrics (IPP).
Track quality and productivity metrics; lead improvement initiatives.
Oversee daily ITS claims workflows and ensure timely, accurate adjudication across all claim types.
Serve as the primary escalation point for the most complex, sensitive, or high‑impact ITS/BlueCard claim issues.
Partner with leadership to refine ITS policies, update procedures, and support operational strategy
Act as a liaison with BCBS host/home plans and external partners for escalated claim issues.