Fraud Claims Operations Representative Jobs in Ohio

Job Description

We're hiring an FEP Claims Team Leader, Operations to join the Claims Team! Responsible for leading a team of departmental staff, including oversight of workload and execution of operational goals. Provides guidance on problem resolution, ensures member and customer satisfaction, and maintains compliance with applicable requirements. Leads performance coaching, development, and trend analysis, and serves as a key liaison between frontline staff, leadership, and cross functional partners.

What You'll Do

• Manage day-to-day workload to achieve business objectives; provide leadership and direction to the team and execute team goals and expectations.

• Act as a resource for the team; provide assistance on work processes and procedures.

• Foster a positive, accountable, and collaborative team culture.

• Serve as the primary point of contact for operational updates and escalations, including direct, customer facing engagement as needed.

• Ensure employees are properly trained in processes and procedures and respond professionally, courteously, quickly, and accurately to all inquiries from internal and external customers.

• Provide ongoing coaching and development feedback to team members. Conduct regular coaching conversations and formal performance evaluations.

• Collaborate with other departmental teams to establish performance goals and monitor progress against those goals.

• Partner with cross functional teams to identify and address system or process gaps.

• Identify trends, determine root causes, and initiate appropriate action to resolve issues.

• Identify, document, and report system and process problems/trends using root cause analysis and implement solutions

• Conduct random audits of the team's work. Review audit results with employees and create performance improvement plans as necessary.

• May develop short and long-term service objectives and methods and implement these methods when approved.

• Respond quickly and accurately to escalated issues from clients and customers.

• May represent the department on corporate projects (i.e., divisional, corporate, etc.).

What You Bring

• Bachelor's degree or advanced degree (where required)

• 5+ years of experience in related field.

• In lieu of degree, 7+ years of experience in related field.

Bonus Points (Preferred qualifications)

• Prior Federal Employee Program (FEP) experience strongly preferred.

• 2-3 years of people leadership or team lead experience preferred.

• Claims operations experience is desirable.

WhatYou'llGet

• 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 any states listed on this 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.

$66,998.00 - $107,197.00

Skills

Change Management, Employee Performance Evaluations, Leadership, Operational Efficiency, Performance Management (PM), Performance Review Management, Process Improvements, Project Management, Team Management, Training and Development

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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: HR.Staffing@BCBSNC.com.