Website Blue Cross Blue Shield of Massachusetts
This Jobsfunter Listing is about Blue Cross Blue Shield of Massachusetts in Hingham, MA 2022
About the job
Ready to help us transform healthcare? Bring your true colors to blue.
Provide analytical support to the ITS Claims Operations organization in order to ensure the highest levels of business effectiveness and the achievement of divisional goals.
- Represent ITS Claims Operations in the coordination of multiple/concurrent ITS and Union Blue production activities, ITS releases and operational enhancement projects
- Lead business representative for BCBSA discussions around biannual ITS/Blue2 releases, requirement review sessions with project teams, and cross functional workgroups
- Lead the Claims Ops teams through the ITS Release changes-present new functionality; identify and follow through on readiness action items
- Drive the business analysis around release functionality for inventory management, RE assignment & workarounds as needed
- Lead ITS representation when defining and writing project requirements, testing and implementing system enhancements supporting new business initiatives
- Define and lead the coordinated checkout for ITS/Blue2 or Union Blue functionality changes
- Facilitate, document, and provide direction on discussions with business partners to perform root cause analysis of production issues, identify source of issues, quantify impacts, and develop recommendations to improve or eliminate the issue.
- Identify & drive the effort for system enhancements required to mitigate impact to LDLA and overall Scorecard performance
- Development and documentation of business requirements to implement continuous improvement opportunities, associate process changes, and system enhancements.
- Provide analysis, quantification, trending, prioritization, and escalation support for issues affecting ITS and Union Blue claims
- Report and monitor open activities and timelines for ITS and Union Blue system corrections or enhancements
- Perform trend analysis and identify opportunities to improve the desk level and system efficiency via workflow changes and/or system modifications.
- Utilize reporting tools (Web Focus, Data Warehouse, etc.) and manipulate data in Access, Excel or Word for presentation in order to support inventory management, performance tracking and trending, etc
- Monitor performance and provide recommendations to support divisional goals (Performance Guarantees, BlueCard Scorecard, First Pass Rate, Adjustment rate, LDLA etc.)
- Collaborate with Claims Operations Leaders/Associates to identify opportunities to improve and provide supportesources to improve overall performance.
Qualifications: (Knowledge, skills and abilities)
- Demonstrates a strong ability to identify, analyze, and solve problems
- Ability to thrive in an environment under self-direction amongst constant change
- Experience with taking lead role in projects or workgroups
- Ability to effectively translate customer needs into appropriate specifications and analytic plans, carry out analysis and summarize findings
- Proven ability to present a positive, constructive, and flexible attitude and to encourage/influence change and innovation.
- Strong organizational skills with ability to work under pressure, multitask and prioritize workload
- Ability to identify, communicate, and manage risk
- Proven track record for managing multiple projects and delivering a quality product within agreed upon deadlines.
- Demonstrated ability in identifying opportunities for process improvements, and follow-through to completion
- Understanding of ITS claim data elements and their significance in the determination of claims processing is a plus.
- Basic knowledge of files/tables that support claims processing and the impact of each on claims adjudication.
- Demonstrated experience in operational environment General understanding of BCBSMA product portfolio, benefit provisions, and limitations.
- Strong knowledge of BCBSMA functions/department roles, particularly in the area of Blue Card Claims and Service.
- Demonstrated ability to influence, negotiate, and operate collaboratively as part of a team
- Bachelor’s degree in business or health care related field, or a combination of education and experience providing an equivalent background.
- 3-5 years’ experience in a claims processing environment, preferably at BCBSMA.
Minimum Education Requirements
High school degree or equivalent required unless otherwise noted above
At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. We provide a flexible hybrid work model in which roles are designated as resident (on site 4-5 days/week), mobile (on site 1-3 days/week), or eworker (on site 0-3 days/month).
Blue Cross Blue Shield of Massachusetts, has a COVID-19 vaccination requirement for building entry. Your offer of employment is dependent upon either being fully vaccinated for COVID-19 or an accommodation based on a disability or sincerely held religious belief, practice, or observance by submitting a request to Human Resources.
Company: Blue Cross Blue Shield of Massachusetts
Vacancy Type: Full-time · Associate
Job Location: Hingham, MA
Application Deadline: N/A