Interplan Specialist

Job Description

The Interplan Specialist resolves routine, complex, and escalated issues impacting provider and member claims across the BlueCard Program. This role works independently and in partnership with internal teams, other Blue Cross Blue Shield plans, providers, and members to ensure timely and accurate resolution.

All activities must comply with internal policies (including Compliance), Blue Cross Blue Shield Association (BCBSA) requirements, Interplan Scorecard timeliness metrics, NC Department of Insurance guidelines, CMS regulations, and applicable state and federal laws.  

What You’ll Do

• 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

What You’ll Get 

• The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community  

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

• Medical, dental, and vision coverage along with numerous health and wellness programs   

• Parental leave and support plus adoption and surrogacy assistance   

• 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.

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

*Based on annual corporate goal achievement and individual performance.

$41,600.00 - $66,561.00

Skills

Budgeting, Claims Processing, Collaboration, Customer Service, Detail-Oriented, Documentations, Health Care, Healthcare Claims Processing, Health Insurance, Insurance Claim Handling, Interagency Coordination, Internal Auditing, Internal Stakeholders, Operational Process Improvements, Patient Care, People Management, Regulatory Compliance, Report Development, Researching

JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC. If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: [email protected].

Originally posted on Himalayas