Claims Monitoring Program Manager @ Blue Cross Blue Shield

Blue Cross and Blue Shield of Vermont is looking for a Claims Monitoring Program Manager to join our Payment Integrity team. Our company is built on an unwavering focus on the health of Vermonters, outstanding member experiences and responsible cost management for all the people whose lives we touch. We offer a balanced and flexible workplace, an onsite gym, fitness and wellness programs, a competitive salary and full benefits package including medical and dental insurance, vision, 401K, paid time off and holidays, tuition reimbursement and student loan repayment, dependent caregiver benefits, and resources to support your ongoing personal and professional growth and development.

REMOTE WORK: The Claims Monitoring Program Manager will work at our Berlin, VT office on Tuesdays and Wednesdays, with flexibility to work remotely the rest of the week.

Claims Monitoring Program Manager Responsibilities:

Lead a team responsible for identifying process improvements and changes in Blue Cross VT’s day-to-day operations leading to direct cost avoidance and savings for the Plan.
Manage this team of coders and analysts tasked with identifying overpayments, inconsistencies, and trends in claims data.
Use your exceptional communication skills to facilitate change with Blue Cross VT internal and external stakeholders. Work with Providers to implement these changes, bringing feedback to Blue Cross leaders as needed.
Oversee the professional development of employees to ensure continued growth and advancements by creating an environment that fosters continued learning.
Claims Monitoring Program Manager Qualifications:

Preference will be given to candidates with strong management and communication skills and experience. These qualities outweigh the below qualifications specific to the insurance industry.
BA/BS or equivalent work experience required.
5-7 years of related experience in a health insurance/care setting, or equivalent change management experience.
Expert knowledge of claims processing, including benefit and system configuration, medical policy, reimbursement, and provider contracting.
High-level knowledge of medical coding, including ICD-10, CPT, HCSPCS, CMS guidelines, etc.
Experience with Agile methodology, Scrum and sprints desired.
Claims Monitoring Program Manager Benefits:

Health insurance (including vision)
Dental coverage (free to employees)
Wellbeing Program
401(k) with employer match + automatic employer contribution
Life Insurance
Disability Insurance
Combined time off (CTO) – 20 days per year + 10 paid holidays
Tuition Reimbursement
Student Loan Repayment
Dependent Caregiver Benefits

To apply, please visit: https://workforcenow.adp.com/mascsr/default/mdf/recruitment/recruitment.html?cid=c0391ed8-867c-4bc1-889e-a5e307b5d8c4&ccId=19000101_000001&jobId=535632&source=CC2&lang=en_US