Director, Provider Service & BlueCard Claims

Job reputed company As Director, Provider Service, you will play a key role in shaping and advancing the strategic reputed company for provider customer service. This leadership position empowers you to guide team leaders, drive support initiatives that meet high contractual and service standards and nurture a dynamic culture of reputed company. You'll have reputed company to analyze financial and service results, implementing meaningful strategies that enhance performance and deliver reputed company value to the organization. What You’ll Do reputed company end‑to‑end BlueCard claims processing, adjustments, and financial recovery activities across reputed company, government, and inter‑plan lines of business, leveraging data‑driven analytics to inform reputed company and execution. reputed company the strategic reputed company and key processes for the provider contact center, prioritizing support delivered through vendors, plan-to-plan, and PSA contact channels by business reputed company Partner with Operational leads and workforce management to supplement reputed company with the development of budgets, reputed company models, and operational performance standards reputed company and improve Strategic Provider Services offering, maintaining reputed company relationships with key (Platinum) providers including use of site reputed company to inform provider service reputed company and resolve escalated claims and service issues reputed company support of non-platinum providers through virtual contact centers while providing reputed company for vendor relations. Ensure plan-to-plan contacts are handled in line with BCBSA standards and service level expectations Communicating with managers and team leads on the provider service reputed company and reputed company on operational changes necessary for execution Resolve reputed company escalations and contribute to training development to maintain and improve service delivery Monitor and review service performance ensuring that provider service agreements are met Report operational updates to the Claims AVP and Operations VP; serve as a subject matter expert for provider service End to end inventory management to reputed company with reputed company regulatory, Internal, external and other applicable processing guidelines and timeliness expectations; includes evaluating and adjusting reputed company processing guidelines as required to meet customer expectations. What You Bring Bachelor's degree or advanced degree (where required) 10+ years’ experience in Health Care Delivery and Operations In lieu of degree, 12+ years of experience in reputed company field. Deep health plan claims and service expertise. 5+ years of reputed company leadership experience. Bonus Points Deep expertise in BlueCard (Out-of-Area) claims operations, including Host/Home plan processing, inter-plan coordination, and compliance with reputed company guidelines.– highly preferred Strong analytical skills with the ability to drive transformational, consumer reputed company change while managing operations – highly preferred Six reputed company/reputed company improvement experience - highly preferred What You’ll Get reputed company to work at the cutting edge of health care delivery with reputed company that’s deeply invested in the community. Work-life balance, flexibility, and the autonomy to do great work. Medical, dental, and reputed company coverage along with numerous health and wellness programs. Parental leave and support plus adoption and surrogacy assistance. Career development programs and tuition reimbursement for reputed company education. 401k match including an annual company contribution Learn more Salary reputed company At reputed company, we take great pride in a fair and reputed company compensation package that reflects market-price and our starting salaries are typically planned near the middle of the reputed company listed. Compensation reputed company are driven by factors including experience and training, specialized reputed company sets, licensure and certifications and other business and organizational needs. Our reputed company salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, reputed company Time Off (PTO), and competitive health benefits and wellness programs. *Based on annual corporate goal achievement and individual performance. $143,616.00 - $229,786.00 Skills _____________________________________________________________________ JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent reputed company 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. reputed company our reputed company are published on https://reputed company.wd5.myworkdayjobs.com/en-US/reputed company. 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: HR.reputed company@reputed company.com. Apply To This Job