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 on Interplan processes across all lines of business, including Shared Marketplace Agreements (SMA)
• Research and resolve complex healthcare claims issues by navigating multiple systems, validating data (e.g., pricing, benefits, prior authorizations), and ensuring accurate adjudication
• Identify trends, 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 teams regarding claims processing, appeals, and related workflows
• Recommend and implement process improvements by identifying gaps, 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 presenting Interplan insights to internal stakeholders
• Develop, maintain, and analyze reports to monitor performance, identify issues, and support business decision-making

What You Bring

• High school diploma or GED
• 3+ years of experience in related field.
• IPP Home Claims Training or IPP Home Customer Service Training required

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

Where You’ll Work

Our Hybrid Flex approach is built on presence with a purpose – giving you flexibility to work remotely with intentional in-person connection – that supports a workplace that’s flexible, connected, and future focused. In a Hybrid-Flex role, you’ll work in the office at least two days a week for collaboration and connection. In a Remote Flex role, you’ll work 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

$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