SUMMARY:
The Claims Operations Specialist is responsible for ensuring the accuracy and timeliness of Medicare Advantage ITS claims processing for the BlueCard program. In this role, the Specialist will be responsible for performing, developing, analyzing and evaluating claims operational performance and processes specifically related to ITS claims. This role also requires effectively participating in discussions with staff, management, providers, internal teams and business process outsourcing vendors as well as through reporting and quality monitoring and oversight activities with the expectancy of implementing process improvement initiatives that will strengthen claims quality and performance leading to operational excellence, continuous service improvement for our customers and maintaining compliance. This role is also responsible for ongoing training of BlueSquared activities for all employees and vendors requiring such access.
RESPONSIBILITIES/TASKS:
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