Lead Claims Bluecard Analyst

Healthcare Management Administrators

BlueCard/ITS Claims Specialist ensuring accurate adjudication across complex healthcare claims. Collaborating with stakeholders and leading initiatives to improve claims processing and member experience.

Posted 7/13/2026full-timeRemote • Washington • 🇺🇸 United StatesSenior💰 $48 - $56 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in ITS/BlueCard claims processing, pricing methodologies, and BCBS national programs, with strong analytical skills to interpret data and drive improvements. Proven leadership and communication abilities to coach teams and manage complex workflows effectively.

Highest-signal resume keywords

Claims Processing ExperienceITS/BlueCard Processing ExpertiseLeadership ExperienceExpert Excel SkillsAnalytical Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ProcessingITS/BlueCard ProcessingPricing MethodologiesData AnalysisRoot-Cause AnalysisQuality Metrics TrackingAdjudicationProject CoordinationSystem TestingPolicy Refinement

Soft Skills

LeadershipCommunicationCoachingTeam Performance ManagementPrioritization

Industry Keywords

Insurance IndustryBCBSInterPlanContinuity-of-CareDisruption AnalysisPerformance MetricsOperational StrategyEscalation ManagementComplex WorkflowsOperational Program Requirements

About the role

Key responsibilities & impact

Monitor BlueWeb for Association updates and analyze release notes to determine claim, pricing, and training impacts.
Track provider terminations and communicate impacts; coordinate continuity-of-care and disruption analysis.
Serve as SME on BlueCard/ITS claims processing rules and operational program requirements. Coach team members accordingly on guidelines and changes.
Coordinate Association projects and rule interpretation with Regence and InterPlan Executives.
Act as key escalation point for Plan-to-Plan issues.
Cascade InterPlan communications to internal teams.
Oversee complex ITS/BlueCard workflows; lead system and pricing enhancement projects.
Test and validate system updates; refine ITS/BlueCard policies and procedures.
Conduct root-cause analysis on recurring issues and implement improvements.
Monitor and communicate InterPlan performance metrics (IPP).
Track quality and productivity metrics; lead improvement initiatives.
Oversee daily ITS claims workflows and ensure timely, accurate adjudication across all claim types.
Serve as the primary escalation point for the most complex, sensitive, or high-impact ITS/BlueCard claim issues.
Partner with leadership to refine ITS policies, update procedures, and support operational strategy.
Act as a liaison with BCBS host/home plans and external partners for escalated claim issues.

Requirements

What you’ll need

High school diploma required, Associate’s Degree preferred
5-7+ years of claims processing experience within the insurance industry
3-5 years of BCBS claims processing experience
1+ years of proven leadership experience
Expert Excel skills with the ability to manipulate data independently
Expert-level understanding of ITS/BlueCard processing, pricing methodologies, and BCBS national programs.
Strong leadership, communication, and coaching abilities.
Ability to manage competing priorities and support team performance.
High-level analytical skills with the ability to interpret data and drive improvements.

Benefits

Comp & perks

Seventeen (IC) days paid time off (individual contributors)
Eleven paid holidays
Two paid personal and one paid volunteer day
Company-subsidized medical, dental, vision, and prescription insurance
Company-paid disability, life, and AD&D insurances
Voluntary insurances
HSA and FSA pre-tax programs
401(k)-retirement plan with company match
Annual $500 wellness incentive and a $600 wellness reimbursement
Remote work and continuing education reimbursements
Discount program
Parental leave
Up to $1,000 annual charitable giving match