IDR Administrative Specialist

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. The position is eligible for a hybrid or onsite work arrangement in accordance with the company’s Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.

• Log incoming work items into designated systems to ensure proper tracking and documentation.
• Review work items against standardized eligibility and processing rules to determine the appropriate next steps.
• Perform accurate data entry across multiple systems, ensuring completeness and data integrity.
• Route or advance work items to the appropriate next stage based on established workflows.
• Maintain adherence to defined turnaround time expectations and productivity standards.
• Apply consistent interpretation of procedural guidelines and escalates exceptions or unclear scenarios as needed.
• Support updates to workflows and procedures based on regulatory or business changes, including those driven by CMS.
• Participate in team meetings, training sessions, and process improvement discussions to ensure alignment and continuous improvement.
• Maintain an ongoing understanding of processing rules, eligibility criteria, and system requirements.

• Ability to learn and apply federal and Blue Cross Blue Shield Association IDR eligibility and processing requirements for BCBSKS owned and serviced contracts.
• High degree of accuracy with structured process following and 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.
• Understanding of 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.

High school graduate or equivalent is required. Education or experience in administrative processing, claims, credentialing, or healthcare operations is preferred. Minimum two years of BCBSKS operational experience, including customer service, claims or membership, OR three years of demonstrated experience working with medical insurance or data entry and system‑based workflow management is required.

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 a sit/stand desk is available. For candidates eligible for work from home or hybrid telecommuting status, onsite attendance at the main campus can be requested at any time.

Must be able to travel as requested.

$23.58‑29.40 hourly. Blue Cross and Blue Shield of Kansas offers competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is an estimate based on what a successful candidate might be paid. All offers presented are reviewed to ensure fair, equitable pay.

• Health, Vision, and Dental insurance
• Six weeks paid parental leave for new mothers and fathers
• Fertility/Adoption assistance
• Two weeks paid caregiver leave
• 401(k) plan with matching up to 5%
• Tuition reimbursement
• Health & fitness benefits, discounts and resources
• Incentive pay program (EPIP)

Blue Cross and Blue Shield of Kansas provides equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information, military or veteran status, family or parental status, or any other characteristic protected by applicable law.

Blue Cross and Blue Shield of Kansas conducts pre‑employment drug screening, criminal conviction check, employment verifications and education as part of a conditional offer of employment.