Actisure Policy Specialist

Job Description

Job Description

Who we are.

At Blue Cross Blue Shield Global SolutionsSM (BCBS Global SolutionsSM), we make it easy for people and organizations to access and pay for healthcare abroad. By combining digital innovation with human-centered care, we go above and beyond for our customers and deliver an international healthcare experience that is simple, efficient and human.

Whether our customers live, work, travel or study abroad, we give them the confidence and peace of mind to say yes to new possibilities.

What we're looking for in our Actisure Policy Specialist:

You're a detail-oriented professional who enjoys solving complex problems and ensuring accuracy behind the scenes. You understand that a well-configured policy is the foundation of a seamless claims experience and exceptional member service. You take pride in translating benefit documents into system configurations that support accurate claim adjudication and operational excellence.

You're someone who:

• Has a strong eye for detail and enjoys working with complex benefit and policy information
• Thinks analytically and can interpret insurance certificates, plan designs, and policy requirements
• Balances speed and accuracy while managing multiple priorities and deadlines
• Collaborates effectively across departments to resolve issues and support business goals
• Embraces continuous improvement and enjoys testing, troubleshooting, and refining processes
• Takes ownership of their work and values quality, accountability, and teamwork

Here's the work you'll be doing to support our members around the world: Policy Configuration & Administration

• Review new business, renewal, and change requests submitted through Salesforce
• Analyze policy documentation and benefit requirements to determine the appropriate configuration approach
• Configure group information, benefits, and system settings within Actisure to support accurate claims processing
• Maintain policy records and documentation throughout the policy lifecycle

Benefit Interpretation & Quality Assurance

• Review insurance certificates and benefit documentation to accurately load plan information
• Develop and maintain benefit sheet templates and supporting documentation
• Participate in policy audits and quality reviews to ensure configuration accuracy
• Identify discrepancies and support corrective actions when needed

Testing & Continuous Improvement

• Assist with testing new products, plan enhancements, and system updates
• Build test policies and participate in user acceptance and regression testing activities
• Collaborate with operational and technical teams to evaluate outcomes and improve system performance
• Support ongoing efforts to enhance policy setup processes and procedures

Cross-Functional Collaboration

• Partner with Enrollment & Implementation, Claims, Operations, Training, and other internal teams
• Help develop and document policy configuration procedures and best practices
• Communicate findings, issues, risks, and recommendations clearly and professionally
• Contribute to a collaborative and knowledge-sharing team environment

What success looks like:

The Actisure Policy Specialist will be expected to drive measurable results in:

• Accurate and timely policy setup and maintenance
• Quality and consistency of policy configurations
• Reduced configuration errors and rework
• Successful implementation and testing of new products and enhancements
• Improved operational efficiency through process adherence and continuous improvement
• Strong collaboration with internal business partners and stakeholders

This might be the right fit for you if…

• You have a Bachelor's degree or equivalent experience; Insurance Administration, Business, or Computer Science backgrounds are preferred
• Your resume reflects 2-5 years of experience in operations, claims, audit, customer service, account management, or a related function
• You have strong analytical, organizational, and problem-solving skills
• You can effectively manage multiple priorities while maintaining high quality standards
• You possess excellent written and verbal communication skills
• You are proficient with Microsoft Office applications, including Excel and Word
• You are comfortable making decisions supported by documentation and data

Bonus points if you have:

• Health insurance industry experience
• Advanced knowledge of medical and dental benefit plans
• Experience reviewing and interpreting certificate language and benefit documents
• Familiarity with claims systems, coding, or claims processing guidelines
• Experience working with Actisure, Salesforce, or similar platforms
• Experience participating in system testing, implementations, or operational improvement initiatives

What you’ll get in return:

• Competitive base pay + annual bonus
• Competitive medical plans
• Telemedicine services
• Paid parental leave
• Employee assistance and wellness support
• Free international healthcare coverage

Other great perks:

• Remote work model
• Work-abroad arrangements
• Generous PTO
• Paid holidays, floating holiday, and volunteer day
• Tuition reimbursement
• Career development opportunities
• 401(k) with company match
• Pet insurance, identity theft, and legal coverage

Please visit the employee benefits page on our website for more information on our benefits and perks that support your overall well-being.

EOE