Claims Bluecard Analyst IV, Lead

Role Description

As a BlueCard/ITS Claims Specialist, this role ensures accurate, compliant adjudication across complex BlueCard claims, translates BlueWeb and Association changes into operational action, partners closely with Regence and InterPlan stakeholders, and monitors and improves IPP (InterPlan Program) performance. The Claims Specialist/BlueCard Hybrid serves as an enterprise escalation point, leads cross-functional initiatives, and drives training, quality, and process improvements that safeguard claim outcomes and member experience.

What YOU will do:

• BlueWeb Review:
  • 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.
• Collaboration with Regence:
  • 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.
• Operational Change Leadership:
  • 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.
• IPP Score Monitoring:
  • Monitor and communicate InterPlan performance metrics (IPP).
  • Track quality and productivity metrics; lead improvement initiatives.
• Claims Adjudication:
  • 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.

Qualifications

• 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.

Compensation

The base salary range for this position in the greater Seattle area is $47.89/hr - $55.76/hr for a level IV and varies dependent on geography, skills, experience, education, and other job or market-related factors. While we are looking for level I, we may consider level II for highly qualified candidates.

Benefits

• 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.

How we Support your Work, Life, and Wellness Goals

At HMA, we believe in recognizing and celebrating the achievements of our dedicated staff. We offer flexibility to work schedules that support people in all time zones across the US, ensuring a healthy work-life balance. Employees have the option to work remotely or enjoy the amenities of our renovated office located just outside Seattle with free parking, gym, and a multitude of refreshments. Our performance management program is designed to elevate career growth opportunities, fostering a collaborative work culture where every team member can thrive. We also prioritize having fun together by hosting in-person events throughout the year including an annual all hands, summer picnic, trivia night, and a holiday party.

Company Description

HMA is the premier third-party health plan administrator across the PNW and beyond. We relentlessly deliver on our promise to provide medium to large-size employers with customized health plans. We offer various high-quality, affordable healthcare plan options supported with best-in-class customer service.