Provides and interprets all program guidance internally regarding Inter-Plan Program policies and manuals being accountable for all Inter-Plan governance and policy matters. Monitor and effectively manage inventory of unresolved complex inquiries to provide timely follow-up and accurate resolution of BlueCard claims for HMSA customers.
Use ITS, Blue2 systems, reference databases, applications, and other tools to research claims questions and inquiries
Coordinate communication and decisions related to Inter-Plan Programs and other Inter-Plan functions. Lead and distribute BCBSA communications to appropriate individuals within the Plan working with various internal departments. This includes coordinating payment for claims due to dual or more membership.
Lead and participate to reporting team in reporting requests to produce data and ensure BlueCard clams are being processed and paid accurately. Compile reports about incidents, events, and updates regarding claims processing issues and conflicts. This includes providing recommendations and resolutions.
Coordinate with multidisciplinary teams; present and influence senior decision makers to secure necessary resources and funding to support National and BCBS Association projects.
Apply advanced knowledge and service as unit's SME. Participate and lead meetings on workflow changes, identifying training needs, process improvements, and project implementations including our vendor and internal areas
Complete or participate in corporate training, compliance certification or initiatives as directed by upper management
Performs all other miscellaneous responsibilities and duties as assigned or directed.

BlueCard Program Coordinator

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