IDR Administrative Specialist

Blue Cross and Blue Shield of Kansas•Topeka, KS

1d•$24 - $29•Hybrid

About The Position

The IDR (Independent Dispute Resolution) Administrative Specialist is responsible for the intake, review, and routing of operational work items to ensure accurate and timely processing. This role applies standardized business rules to assess eligibility, perform data entry, and advance work through defined workflows. The Specialist supports operational efficiency by maintaining accuracy, timeliness, and compliance with internal guidelines and externally driven requirements, including regulatory changes. This position requires a high level of attention to detail, consistency in applying rules, and the ability to adapt to evolving processes, including those influenced by federal guidance such as CMS. This position is eligible to work hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.

Requirements

Must be able to learn and apply federal and Blue Cross Blue Shield Association IDR eligibility and processing requirements for BCBSKS owned and serviced contracts.
Work with high degree of accuracy and demonstrate ability to follow structured processes and apply consistent decision-making
Effective time management and ability to meet deadlines
Basic analytical skills to review and interpret information against defined criteria
Adaptability to process changes and evolving regulatory requirements
Understand sequential workflow procedures.
Proficiency with operating systems and standard business software
Demonstrated verbal and written communication and human relation skills with the ability to interact positively at all levels with internal and external peers.
High school graduate or equivalent is required.
Minimum two years of experience BCBSKS operational experience to include customer service, claims or membership OR 3 years demonstrated experience working with medical insurance or data entry and system-based workflow management is required.

Nice To Haves

Education or Experience in administrative processing, claims, credentialing, or healthcare operations preferred.

Responsibilities

Responsible for intake and logging of incoming work items into designated systems to ensure proper tracking and documentation.
Reviews work items against standardized eligibility and processing rules to determine appropriate next steps.
Performs accurate data entry across multiple systems, ensuring completeness and data integrity.
Routes or advances work items to the appropriate next stage in the process based on established workflows.
Maintains adherence to defined turnaround time expectations and productivity standards.
Applies consistent interpretation of procedural guidelines and escalates exceptions or unclear scenarios as needed.
Supports updates to workflows and procedures based on regulatory or business changes, including those driven by CMS or other governing entities.
Participates in team meetings, training sessions, and process improvement discussions to ensure alignment and continuous improvement.
Maintains an ongoing understanding of processing rules, eligibility criteria, and system requirements.