Top 634 Claims processing Jobs in North Carolina

Manager, Claims
Blue Cross and Blue Shield of North Carolina —North Carolina
- $107,901 - $172,642 a year
- Full-time
- Remote
- 8 years
- Supervising experience
- Bachelor's degree
- Health insurance
- Dental insurance
Facets Analyst
EAPPS TECH LLC dba Magicforce —Raleigh, NC
- $60 - $65 an hour
- Remote
- Oracle
- Mid-level
- Analysis skills
Quick Apply
Claim Benefit Specialist
CVS Health —Raleigh, NC
- $17.00 - $34.15 an hour
- Full-time
- Customer service
- Windows
- High school diploma or GED
- Health insurance
- Dental insurance
6d
Claims Coordinator - CBO
CarolinasDentist —North Carolina
- $18 - $24 an hour
- Full-time
- Remote
- Dental office
- HIPAA
- Mid-level
- Paid holidays
- Health insurance
Quick Apply
Finance & Accounting Representative
WakeMed Health & Hospitals —Raleigh, NC
- Full-time
- Remote
- Mid-level
- High school diploma or GED
- Business Administration
4d
Billing Specialist
FreedomCare —Charlotte, NC
- $23 - $25 an hour
- Remote
- Research
- Mid-level
- Finance
Quick Apply
5d
Claims Representative
Marsh McLennan Agency —Greensboro, NC
- $37,600 - $70,200 a year
- Full-time
- Hybrid work
- Word processing
- Computer literacy
- Mid-level
- Health insurance
- 401(k)
6d
Claims Specialist II
TRILLIUM HEALTH RESOURCES —North Carolina
- $42,765 - $61,546 a year
- Full-time
- Remote
- Pass drug screening
- Research
- Mid-level
- Paid holidays
- Health insurance
Quick Apply
10d
Claims Specialist III
TRILLIUM HEALTH RESOURCES —North Carolina
- $56,270 - $69,898 a year
- Full-time
- Remote
- Pass drug screening
- Research
- Mid-level
- Paid holidays
- Health insurance
Quick Apply
6d
BI Analyst
Blue Cross and Blue Shield of North Carolina —North Carolina
- $89,174 - $142,679 a year
- Full-time
- Remote
- 3 years
- Analysis skills
- Bachelor's degree
- Health insurance
- Paid time off
Inside Claims Representative I
Erie Insurance —Cary, NC
- $44,936 - $71,781 a year
- Full-time
- Hybrid work
- Customer service
- Adults
- Research
- Disability insurance
- Health insurance
7d
Manager, Claims
TRILLIUM HEALTH RESOURCES —North Carolina
- $70,338 - $94,705 a year
- Full-time
- Remote
- Pass drug screening
- Mid-level
- Driver's License
- Paid holidays
- Health insurance
Quick Apply
10d
Claims Team Leader
PacificSource Health Plans —North Carolina
- $50,830.78 - $81,329.23 a year
- Full-time
- Microsoft Word
- Microsoft Excel
- HIPAA
7d
Accounts Receivable Specialist- Unidentified Cash WFH (Flex time after training!)
Labcorp —Burlington, NC
- $17.75 - $21.00 an hour
- Full-time
- Research
- High school diploma or GED
- Fair chance
- Employee stock purchase plan
- Disability insurance
3d
Claims Adjudication Associate
Judi Health —Charlotte, NC
- $82,400 - $103,000 a year
- Weekends as needed
- Hybrid work
- HIPAA
- Mid-level
- Office
Quick Apply
Data Exchange Analyst - Claims Operations
Judi Health —Charlotte, NC
- $96,800 - $121,000 a year
- Hybrid work
- HIPAA
- Mid-level
- Office
Quick Apply
Pharmacy Tech Support / Call Center Rep (Remote Work from Home)
IQVIA —Raleigh, NC
- $18 an hour
- Full-time
- Remote
- Spanish
- English
- High school diploma or GED
- Work from home
Senior HR Partner - Compensation & Benefits
PIP Global Safety —Charlotte, NC
- HIPAA
- Research
- Office
- Dental insurance
- 401(k)
Quick Apply
Senior Payroll and Benefits Coordinator
Sears Contract, Inc —Raleigh, NC
- $70,000 - $90,000 a year
- Full-time
- Background check
- Mid-level
- Office
- AD&D insurance
- Disability insurance
Quick Apply
5d
Technician, Process -Beverage Manufacturing (on site)
LASSONDE PAPPAS AND CO INC —Hendersonville, NC
- Full-time
- Engineering
- Research
- Mid-level
- Disability insurance
- Health insurance
7d

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Manager, Claims

Blue Cross and Blue Shield of North Carolina -
North Carolina

Apply Now

Job Details

Full-time
$107,901 - $172,642 a year

Benefits

Health insurance
Dental insurance
Tuition reimbursement
Paid time off
Adoption assistance
Parental leave
Vision insurance
401(k) matching

Qualifications

Performance monitoring
Staff performance monitoring
Appeals
Operational analysis
Preparation of internal financial performance reports
Financial data reconciliation
Data analysis reporting
Medicare
Team supervision
Accounts receivable management
Process design
Performance Reporting
Refund processing
8 years
Supervising experience
Bachelor's degree
Customer engagement
Financial data management
Medical insurance appeals management
Recruiting
Organizational skills
Managing insurance claims teams
Medical accounts receivable management
Medical claims submission
Request for proposal
Insurance (Financial sectors)
Business operations
Employee engagement
Customer satisfaction improvement
Senior level

Full Job Description

The Manager, Claims implements end to end service model across provider segments and ensures delivery against business targets. The role sets performance and process targets within customer segment(s) to enable high level of claims processing, claims financial processing, and customer service. Manages claims submission, refunds, and recovery from all lines of business for assigned customer segment(s). Collaborates with claims leadership to understand customer segment(s) and contractual obligations. This role is also responsible for claims accounting and financial reporting.

What You'll Do

Streamline shared processing to reduce management by exception
Set operational process to address market trends, BCBSNC capabilities and customer demand
Manage accounting and financial reporting functions in support of the Finance Division including overseeing the gathering, preparation, analysis, and reconciliation of financial data to ensure compliance with accepted accounting principles and standards.
Research and resolve banking issues.
Participate in projects to improve and/or facilitate claims processing, recovery, and accounting functions.
Manage financial recovery activities including refunds and collections
Manage team leads and staff by efficiently driving work volume to keep high level of utilization and engagement in the group
Resolve complex claims appeal by coordinating with different stakeholders for certain high value claims
Collaborate with Audit and Payment Integrity to sustain a pre-determined level of accuracy and quality
Design and develop tools and techniques for improvements. Identifies needed process and procedural changes which will result in improved customer satisfaction.
Negotiate Claims ASO performance guarantees, reviews, approvals, and client RFPS in collaboration with Sales organization
Serve as ASO Claims Subject Matter Expert and single point of contact for performance monitoring and troubleshooting.
Represent Claims Operations to ASO executives providing data, reports, analytics, and expertise routinely and on demand.
Support ASO Channel lead serving as the Claims ASO Subject Matter Expert and acting as single point of contact both internally and to the ASO for all Claims, Claims Recovery, and Claims Accounting related escalations.

What You Need

Bachelor's degree or advanced degree (where required)
8+ years of experience in related field.
In lieu of degree, 10+ years of experience in related field.

Bonus

Demonstrated claims operations experience in a regulated claims environment (Medicare, government programs, or similar).
Experience leading claims teams and performance management.
Proven understanding of claims systems and processing workflows
Data analytics and reporting experience.
Experience with Facets or similar claims platforms strongly preferred.

What You’ll Get

The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community
Work-life balance, flexibility, and the autonomy to do great work
Medical, dental, and vision coverage along with numerous health and wellness programs
Parental leave and support plus adoption and surrogacy assistance
Career development programs and tuition reimbursement for continued education
401k match including an annual company contribution
Learn more

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

Based on annual corporate goal achievement and individual performance.

$107,901.00 - $172,642.00

Skills

Accounts Receivable (AR), Claims Analysis, Claims Management, Claims Processing, Claims Resolution, Claims Submission, Documentations, Financial Processing, Health Insurance, Insurance Claim Handling, Insurance Claims Processing, Insurance Industry, Medicare Advantage, People Management, Recruiting

_____________________________________________________________________

JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC. If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: [email protected].

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Refine Your Search

claims processing jobs in north carolina

Manager, Claims

Facets Analyst

Claim Benefit Specialist

Claims Coordinator - CBO

Finance & Accounting Representative

Billing Specialist

Claims Representative

Claims Specialist II

Claims Specialist III

BI Analyst

Inside Claims Representative I

Manager, Claims

Claims Team Leader

Accounts Receivable Specialist- Unidentified Cash WFH (Flex time after training!)

Claims Adjudication Associate

Data Exchange Analyst - Claims Operations

Pharmacy Tech Support / Call Center Rep (Remote Work from Home)

Senior HR Partner - Compensation & Benefits

Senior Payroll and Benefits Coordinator

Technician, Process -Beverage Manufacturing (on site)

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