Interplan Specialist

WhatYou’llDo

• Serve as a service relationship professional, managing incoming telephonic and electronic inquiries from partner plans from intake through resolution to meet performance metrics and enhance member and provider satisfaction

• Triage and resolve inquiries on first contact whenever possible, documenting outcomes and communicating next steps to members, providers, groups, and internal stakeholders

• Act as a subject matter expert onInterplanprocesses across all lines of business, including Shared Marketplace Agreements (SMA)

• Research and resolve complex healthcare claims issues by navigating multiple systems,validatingdata (e.g., pricing, benefits, prior authorizations), and ensuringaccurateadjudication

• Identifytrends, patterns, and inconsistencies in claims processing or inquiry handling; implement corrective actions and partner with business areas to drive resolution

• Educate providers and customers on proper claims filing practices and BCBSNC policies to reduce errors and improve compliance

• Provide guidance, coaching, and feedback to internal teamsregardingclaims processing, appeals, and related workflows

• Recommend and implement process improvements byidentifyinggaps, inefficiencies, and operational risks across systems and workflows

• Serve as a point of contact for audits and projects, supporting planning, testing, training, and implementation activities

• Lead or support special projects, including data analysis, reporting, and presentingInterplaninsights to internal stakeholders

• Develop,maintain, and analyze reports tomonitorperformance,identifyissues, and support business decision-making

What You Bring

• High school diploma or GED

• 3+ years of experience in relatedfield.

• IPP Home Claims Training or IPP Home Customer Service Trainingrequired

Bonus Points

• Knowledge of NC DOI and CMS regulatory requirements

• Experience supporting audits, projects, or process improvement initiatives preferred

WhatYou’llGet

• The opportunity to work at thecutting edgeof health care delivery with a teamthat’sdeeply invested in the community

• Work-life balance, flexibility, and the autonomy to dogreat work

• Medical, dental, and vision coverage along withnumeroushealth and wellness programs

• Parental leave and support plus adoption and surrogacyassistance

• Career development programs and tuition reimbursement for continued education

• 401k match including an annual company contribution

• Learn more

WhereYou’llWork

Our Hybrid Flex approach is builton presencewith a purpose – giving you flexibility to work remotely with intentional in-person connection – that supports a workplacethat’sflexible, connected, and future focused.

In a Hybrid-Flex role,you’llwork in the office at least two days a week for collaboration and connection. In a Remote Flex role,you’llwork virtually, with a few in-office visits each year for meaningful moments that matter.

Whether your role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in anystateslistedonthis job posting. Onsite expectations will be discussed during the interview process.

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