FEP Manager, Claims

Blue Cross and Blue Shield of North Carolina•Remote Flex - North Carolina, NC

1d•$107,901 - $172,642•Hybrid

About The Position

The FEP Manager, Claims implements an end-to-end service model across provider segments and ensures delivery against business targets. The role establishes performance and process targets within assigned customer segments to support high levels of claims processing, claims financial processing, and customer service. It manages claims submission, refunds, and recovery across all lines of business for assigned customer segments and collaborates with claims leadership to understand customer segments and contractual obligations. The role is also responsible for claims accounting and financial reporting.

Requirements

Bachelor's degree or advanced degree where required; alternatively, 10 or more years of related experience in lieu of a degree.
At least 8 years of experience in a related field.

Nice To Haves

Experience supporting Federal Employee Program (FEP) claims operations.
Strong knowledge of healthcare claims processing, recovery, refunds, and/or appeals.
Experience with claims accounting, financial reconciliation, or financial reporting.
Familiarity with Blue Cross Blue Shield plans, CMS, or other highly regulated healthcare environments.
Experience leading high-volume claims operations teams, including team leads or people managers.
Demonstrated success with process improvement, operational efficiency, and claims quality initiatives.

Responsibilities

Streamline shared processing to reduce management by exception.
Set operational processes to address market trends, BCBSNC capabilities, and customer demand.
Manage accounting and financial reporting functions supporting the Finance Division, including gathering, preparing, analyzing, and reconciling financial data to ensure compliance with accepted accounting principles and standards.
Research and resolve banking issues.
Participate in projects to improve or facilitate claims processing, recovery, and accounting functions.
Manage financial recovery activities, including refunds and collections.
Manage team leads and staff, driving work volume to maintain high utilization and engagement.
Resolve complex claims appeals by coordinating with stakeholders for certain high-value claims.
Collaborate with Audit and Payment Integrity to sustain a predetermined level of accuracy and quality.
Design and develop tools and techniques for improvement; identify process and procedural changes that improve customer satisfaction.
Negotiate Claims ASO performance guarantees, reviews, approvals, and client RFPs in collaboration with the Sales organization.
Represent FEP Claims Operations by providing data, reports, analytics, and expertise routinely and on demand.
Serve as the Claims FEP subject matter expert and single point of contact internally and externally for escalations related to FEP Claims, Claims Recovery, and Claims Accounting.