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Enterprise Operations

The Enterprise Operations Division provides high-quality service and support to our members, participating providers, brokers and group administrators.

The Enterprise Operations Division includes the following functional areas critical to delivering benefits and service to our customers:

  • Benefit Coding & Billing, Enrollment & Administration teams manage individual and group accounts, member enrollment files and premium billing requirements. They also ensure that benefit plans are correctly coded and categorized in our systems to ensure accurate:
    • Claims processing
    • Payment information
    • Account set-up
    • Benefit portals
  • Claims Operations teams are responsible for processing claims and service transactions timely, accurately and efficiently to support our members and providers.
    • The teams handle claims and certain transactions for all products, including:
      - Medicare Advantage
      - Medicaid
      - Federal Employee Program® (FEP®)
      - BlueCard®
    • The teams also handle specialty and ancillary services, including:
      - Coordination of Benefits
      - Medical policy
      - Research and recovery
  • Call Center teams service our members in all market segments, handling questions/issues such as:
    • Appeals
    • Benefits
    • Billing
    • Claims
  • The Finance, Data Reporting & Analysis and Discovery/Recovery team is responsible for business analysis and reporting to support financial management, continuous improvement and performance measures for the Enterprise Operations Division.
  • The Shared Services team supports our overall service delivery, workforce management and planning, quality assurance and coaching of the Enterprise Operations Division. Shared Services also leads the initial claim and correspondence routing in our Operations Support Center.