IDR Administrative Specialist

Topeka, KS, USA|Remote, Onsite

Job Overview

Compensation

Hourly

Range $23.58 - $29.40

Benefits

Health Insurance

Vision Insurance

Dental Insurance

Paid parental leave

fertility assistance

Adoption assistance

paid caregiver leave

401(k) plan matching

Tuition Reimbursement

Health and fitness benefits

Job Description

Blue Cross and Blue Shield of Kansas (BCBSKS) is a highly respected health insurance provider with over 80 years of steadfast commitment to the community, compassion, and delivering quality care to Kansans. As one of the most trusted companies in Kansas, BCBSKS prides itself on fostering an inclusive and dynamic work environment where employees are valued, respected, and empowered. The company is dedicated to supporting its employees' professional growth through ongoing training and development programs, while promoting a family-first culture with a total rewards package that emphasizes paid vacation, sick leave, and generous parental benefits immediately available upon hire. BCBSKS offers a flexible work environment, enabling employees to work onsite or hybrid in accordance with its telecommuting policy, while providing a collaborative atmosphere filled with passionate and driven individuals aiming to make a positive impact on the health and well-being of the community they serve.

The Independent Dispute Resolution (IDR) Administrative Specialist role at BCBSKS plays a crucial part in ensuring operational efficiency and regulatory compliance within the claims and membership processing areas. This role involves the careful intake, review, and routing of operational work items in accordance with standardized business rules and defined workflows. The IDR Administrative Specialist must maintain high levels of accuracy, timeliness, and compliance with internal guidelines as well as externally driven requirements such as changes mandated by the Centers for Medicare & Medicaid Services (CMS). Additionally, the position requires adaptability to evolving processes and the ability to consistently apply procedural guidelines with attention to detail. Working in this position, you will be responsible for handling critical tasks such as data entry across multiple systems, assessing eligibility for Blue Cross Blue Shield Association IDR contracts, and advancing work through various processing stages. This role supports continuous improvement initiatives by participating in team meetings, training sessions, and workflow updates to ensure alignment with regulatory updates and organizational goals. With a competitive hourly wage ranging from $23.58 to $29.40, this non-exempt position offers stability and growth opportunities within a company deeply rooted in Kansas’ healthcare landscape. Applicants for this role must reside in Kansas or Missouri or be willing to relocate as a condition of employment.

Job Requirements

High school diploma or equivalent
Two to three years of relevant experience in healthcare operations, claims processing, or administrative roles
Ability to work with high degree of accuracy and follow structured processes
Time management skills and ability to meet deadlines
Basic analytical and problem-solving skills
Adaptable to evolving regulatory and operational changes
Strong communication skills
Proficiency in computer systems and business software
Ability to learn complex eligibility criteria and procedural rules
Willingness to work onsite, hybrid, or remote with potential travel as needed

Job Qualifications

High school graduate or equivalent
Education or experience in administrative processing, claims, credentialing, or healthcare operations 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
Ability to learn and apply federal and Blue Cross Blue Shield Association IDR eligibility and processing requirements
Strong attention to detail 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
Proficiency with operating systems and standard business software
Demonstrated verbal and written communication and interpersonal skills with ability to interact positively at all levels

Job Duties

Intake and logging of incoming work items into designated systems to ensure proper tracking and documentation
Review work items against standardized eligibility and processing rules to determine 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 in the process based on established workflows
Maintain adherence to defined turnaround time expectations and productivity standards
Apply consistent interpretation of procedural guidelines and escalate exceptions or unclear scenarios as needed
Support updates to workflows and procedures based on regulatory or business changes, including those driven by CMS or other governing entities
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