IDR Administrative Specialist

Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.

Why Join Us?

* Make a Positive Impact:
Your work will directly contribute to the health and well-being of Kansans.

* Family Comes First:
Total rewards package that promotes the idea of family first for all employees. Paid vacation and sick leave with paid maternity and paternity available immediately upon hire

* Professional Growth Opportunities:
Advance your career with ongoing training and development programs.

* Dynamic Work Environment:
Collaborate with a team of passionate and driven individuals in a work environment that promotes flexibility.

* Trust and Stability:
Work for one of the most trusted companies in Kansas with over 80 years of commitment, compassion and community.

* Inclusive Work Environment:
We pride ourselves on fostering a workplace where everyone is valued and respected.

Benefits & Perks

* Base compensation is only one component of your competitive Total Rewards package

* Incentive pay program (EPIP)

* Health/Vision/Dental insurance

* 6 weeks paid parental leave for new mothers and fathers

* Fertility/Adoption assistance

* 2 weeks paid caregiver leave

* 401(k) plan matching up to 5%

* Tuition reimbursement

* Health & fitness benefits, discounts and resources

Job Summary

The IDR (Independent Dispute Resolution) Administrative Specialist is responsible for the intake, review, and routing of operational work items to ensure accurate and timely processing. This role applies standardized business rules to assess eligibility, perform data entry, and advance work through defined workflows. The Specialist supports operational efficiency by maintaining accuracy, timeliness, and compliance with internal guidelines and externally driven requirements, including regulatory changes.

This position requires a high level of attention to detail, consistency in applying rules, and the ability to adapt to evolving processes, including those influenced by federal guidance such as CMS.

"This position is eligible to work hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment."

What you'll do

* Responsible for intake and logging of incoming work items into designated systems to ensure proper tracking and documentation.

* Reviews work items against standardized eligibility and processing rules to determine appropriate next steps.

* Performs accurate data entry across multiple systems, ensuring completeness and data integrity.

* Routes or advances work items to the appropriate next stage in the process based on established workflows.

* Maintains adherence to defined turnaround time expectations and productivity standards.

* Applies consistent interpretation of procedural guidelines and escalates exceptions or unclear scenarios as needed.

* Supports updates to workflows and procedures based on regulatory or business changes, including those driven by CMS or other governing entities.

* Participates in team meetings, training sessions, and process improvement discussions to ensure alignment and continuous improvement.

* Maintains an ongoing understanding of processing rules, eligibility criteria, and system requirements.

What you need

Knowledge/Skills/Abilities:

* Must be able to learn and apply federal and Blue Cross Blue Shield Association IDR eligibility and processing requirements for BCBSKS owned and serviced contracts.

* Work with high degree of accuracy and demonstrate ability to follow structured processes and apply consistent decision-making

* Effective time management and ability to meet deadlines

* Basic analytical skills to review and interpret information against defined criteria

* Adaptability to process changes and evolving regulatory requirements

* Understand sequential workflow procedures.

* Proficiency with operating systems and standard business software

* Demonstrated verbal and written communication and human relation skills with the ability to interact positively at all levels with internal and external peers.

Education and Experience:

* High school graduate or equivalent is required.

* Education or Experience in administrative processing, claims, credentialing, or healthcare operations preferred.

* Minimum two years of experience BCBSKS operational experience to include customer service, claims or membership OR 3 years demonstrated experience working with medical insurance or data entry and system-based workflow management is required.

Physical Requirements:

* Some lifting of moderately heavy items up to 15 pounds relative to any printed procedure or training manuals.

* Position will be PC work up to 90% of the day to include keying, electronic communications, and virtual meeting attendance; phone usage up to 75% of the day.

* For onsite position assignment, sit / stand desk is available.

* For candidates eligible for work from home or hybrid telecommuting status, onsite attendance at our main campus can be requested as a condition…