Claims Bluecard Analyst IV, Lead

HMA is a third-party health plan administrator in the Pacific Northwest, serving medium to large-size employers with customized health plans.

As a Blue Card/ITS Claims Specialist, you will ensure accurate, compliant adjudication across complex Blue Card claims, translate Blue Web and Association changes into operational action, partner with Regence and Inter Plan stakeholders, and monitor and improve IPP performance.

• Monitor Blue Web 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 Blue Card/ITS claims processing rules and operational program requirements. Coach team members on guidelines and changes.

• Coordinate Association projects and rule interpretation with Regence and Inter Plan Executives.
• Act as key escalation point for Plan-to-Plan issues.
• Cascade Inter Plan communications to internal teams.

• Oversee complex ITS/Blue Card workflows; lead system and pricing enhancement projects.
• Test and validate system updates; refine ITS/Blue Card policies and procedures.
• Conduct root‑cause analysis on recurring issues and implement improvements.

• Monitor and communicate Inter Plan performance metrics (IPP).
• Track quality and productivity metrics; lead improvement initiatives.

• 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/Blue Card 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.

• 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/Blue Card 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.

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.

• Seventeen 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

HMA is an Equal Opportunity Employer.