About this role
Who we are.
At Blue Cross Blue Shield Global SolutionsSM (BCBS Global SolutionsSM), we make it easy for people and organizations to access and pay for healthcare abroad. By combining digital innovation with human-centered care, we go above and beyond for our customers and deliver an international healthcare experience that is simple, efficient and human. Whether our customers live, work, travel or study abroad, we give them the confidence and peace of mind to say yes to new possibilities.
What we're looking for in our Actisure Policy Specialist:
You're a detail-oriented professional who enjoys solving complex problems and ensuring accuracy behind the scenes. You understand that a well-configured policy is the foundation of a seamless claims experience and exceptional member service. You take pride in translating benefit documents into system configurations that support accurate claim adjudication and operational excellence.
You're someone who:
Has a strong eye for detail and enjoys working with complex benefit and policy informationThinks analytically and can interpret insurance certificates, plan designs, and policy requirementsBalances speed and accuracy while managing multiple priorities and deadlinesCollaborates effectively across departments to resolve issues and support business goalsEmbraces continuous improvement and enjoys testing, troubleshooting, and refining processesTakes ownership of their work and values quality, accountability, and teamwork Here's the work you'll be doing to support our members around the world:
Policy Configuration & Administration
Review new business, renewal, and change requests submitted through SalesforceAnalyze policy documentation and benefit requirements to determine the appropriate configuration approachConfigure group information, benefits, and system settings within Actisure to support accurate claims processingMaintain policy records and documentation throughout the policy lifecycle Benefit Interpretation & Quality Assurance
Review insurance certificates and benefit documentation to accurately load plan informationDevelop and maintain benefit sheet templates and supporting documentationParticipate in policy audits and quality reviews to ensure configuration accuracyIdentify discrepancies and support corrective actions when needed Testing & Continuous Improvement
Assist with testing new products, plan enhancements, and system updatesBuild test policies and participate in user acceptance and regression testing activitiesCollaborate with operational and technical teams to evaluate outcomes and improve system performanceSupport ongoing efforts to enhance policy setup processes and procedures Cross-Functional Collaboration
Partner with Enrollment & Implementation, Claims, Operations, Training, and other internal teamsHelp develop and document policy configuration procedures and best practicesCommunicate findings, issues, risks, and recommendations clearly and professionallyContribute to a collaborative and knowledge-sharing team environment What success looks like:
The Actisure Policy Specialist will be expected to drive measurable results in:
Accurate and timely policy setup and maintenanceQuality and consistency of policy configurationsReduced configuration errors and reworkSuccessful implementation and testing of new products and enhancementsImproved operational efficiency through process adherence and continuous improvementStrong collaboration with internal business partners and stakeholders This might be the right fit for you if...
You have a Bachelor's degree or equivalent experience; Insurance Administration, Business, or Computer Science backgrounds are preferredYour resume reflects 2-5 years of experience in operations, claims, audit, customer service, account management, or a related functionYou have strong analytical, organizational, and problem-solving skillsYou can effectively manage multiple priorities while maintaining high quality standardsYou possess excellent written and verbal communication skillsYou are proficient with Microsoft Office applications, including Excel and WordYou are comfortable making decisions supported by documentation and data Bonus points if you have:
Health insurance industry experienceAdvanced knowledge of medical and dental benefit plansExperience reviewing and interpreting certificate language and benefit documentsFamiliarity with claims systems, coding, or claims processing guidelinesExperience working with Actisure, Salesforce, or similar platformsExperience participating in system testing, implementations, or operational improvement initiatives What you'll get in return:
• Competitive base pay + annual bonus • Competitive medical plans • Telemedicine services • Paid parental leave • Employee assistance and wellness support • Free international healthcare coverage
Other great perks:
• Remote work model • Work-abroad arrangements • Generous PTO • Paid holidays, floating holiday, and volunteer day • Tuition reimbursement • Career development opportunities • 401(k) with company match • Pet insurance, identity theft, and legal coverage
Please visit the employee benefits page on our website for more information on our benefits and perks that support your overall well-being.
EOE