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Blue Cross NC
Blue Cross NC
5,001 – 10,000 Employees
HealthcareHealthcare InsuranceInsurance
Blue Cross NC is a health insurance company that provides health plans and related services for individuals and groups. Its work centers on helping members access healthcare coverage, supporting improved health outcomes through health programs and services, and contributing to the wellbeing of the communities it serves.
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Financial Claims Associate - Blue Cross NC (Remote, North Carolina)

Supports health-plan claims finance through invoicing, forecasting, reconciliations, stop-loss analysis, audits, and employer-group reporting for Blue Cross NC.

USUnited StatesNCNorth Carolina
$50,337 – $80,539 / year
RemoteFull-timeJuniorMiddleEnglish RequiredClaims Specialist

Description

  • Manage financial claims expense invoicing, reporting, analysis, reimbursement decisions, and forecasting
  • Create claims expense invoices, weekly statements, forecasts, schedules, and month-end close documentation
  • Evaluate and communicate historical and projected claims expenses alongside stop-loss coverage details
  • Develop loss-coverage financial reports for employer groups and stop-loss vendors
  • Review subgroup spending for employer groups against Administrative Agreement requirements
  • Produce reports and variance analyses for employer groups, stop-loss vendors, Sales, Underwriting, and other stakeholders
  • Validate manual transaction fees and contractual adjustments
  • Develop estimates and adjustments for both new and existing business
  • Reconcile account statements and support monthly run-out and final close-out processes
  • Assemble documentation and data for internal and external audits
  • Handle claims-related client transactions, including claim holds, run-out administrative fees, and employer-group settlements
  • Assess claims for stop-loss coverage eligibility according to contract provisions
  • Investigate utilization, provider details, medical reviews, leave-of-absence provisions, COBRA benefits, and plan documentation
  • Conduct quality checks on operational inquiries to confirm accurate responses and required service levels

Requirements

  • Bachelor’s or advanced degree where required, with at least three years of related experience accepted in place of the degree
  • Up to two years of experience in a related field
  • Capability to manage financial claims expense invoicing, reporting, analysis, reimbursement decisions, and forecasting
  • Ability to prepare claims finance reports, weekly invoices, statements, forecasts, and reconciliations
  • Ability to research claims, plan policies, products, rates, membership, enrollment, underwriting, direct sales, contracts, and program participation
  • Ability to assess stop-loss coverage, high-dollar claims, claimant performance, trends, and contractual adjustments
  • Ability to determine stop-loss benefit eligibility using contract terms
  • Experience supporting audits, variance analysis, quality reviews, and client transactions

Benefits

  • Work-life balance with flexibility and autonomy
  • Medical, dental, and vision insurance
  • Health and wellness initiatives
  • Parental leave and related support
  • Adoption and surrogacy assistance
  • Professional development programs
  • Tuition reimbursement for continuing education
  • 401(k) matching plus an annual company contribution
  • Paid time off
  • Annual incentive bonus
  • Remote work with occasional in-office visits each year for meaningful gatherings

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