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Blue Cross and Blue Shield o…
Most recent job postings at Blue Cross and Blue Shield o…
via ZipRecruiter
schedule_type: Full-time
At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.
Come join us and be part of a purpose driven company who is invested in your future...
Job Summary
This position is responsible for conducting data collection and abstraction of medical records for Quality
At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.
Come join us and be part of a purpose driven company who is invested in your future...
Job Summary
This position is responsible for conducting data collection and abstraction of medical records for Quality projects including supplemental data collection, HEDIS and QRS Surveys. Responsible for interacting with various internal staff, internal departments, and network providers to ensure quality performance and results for Blue Cross managed care products. Responsible for auditing all aspects of BCBSIL clinical quality improvement projects and evaluating PCP compliance with BCBSIL clinical practice guidelines. Also responsible for data analysis, interaction with providers practices to educate on HEDIS measures, gaps in care and quality programs. Translate data into actionable information and determine areas for improvements as well as help implement actions toward improvement and report results to internal and external customers.
Responsibilities
The CQRA position is an integral role with BCBSIL Quality initiatives and outcomes. This role would be attractive to clinicians new to health plan quality with a desire to expand their understanding of quality programs and reporting with a focus on HEDIS /QRS and Health Plan accreditation. The CQRA's primary responsibilities include managing the Quality of Care Complaints, supporting the annual HEDIS /QRS surveys, Quality Improvement Fund project quality abstractions and overreads as well as quality reporting.
The Quality Improvement team falls under the umbrella of Network Clinical Programs and Oversight working collaboratively with BCBSIL medical directors, cross functional teams and Illinois delegated medical groups to influence clinical quality improvement and outcomes as well as support care gap closure through provider engagement, performance monitoring and incentives along with provider education across all lines of business.
Required Job Qualifications:
• Registered Nurse (RN) OR licensed clinician with current, unrestricted license in Illinois.
• Minimum of 3 years clinical practice experience performing medical record review.
• Minimum of 3 years Healthcare or Managed Care experience, including quality improvement and/or project management experience.
• Minimum of 1 year medical record data abstraction.
• Data analysis experience, skills and knowledge of statistical analysis software, and statistical methods and meaning knowledge.
• Ability to adapt to changing priorities and managing a wide range of quality projects.
• Able and willing to travel.
• Verbal and written communication skills.
• Problem resolution skills and ability to work with difficult situations with respect and diplomacy Presentation planning and delivery experience for provider training.
• Preferred Job Qualifications:
• Working knowledge of managed care programs and NCQA Accreditation guidelines.
• Project management experience and skills. QSHR and Epic experience
Sign on Bonus $5,000
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
HCSC Employment Statement:
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status Show more details...
Come join us and be part of a purpose driven company who is invested in your future...
Job Summary
This position is responsible for conducting data collection and abstraction of medical records for Quality projects including supplemental data collection, HEDIS and QRS Surveys. Responsible for interacting with various internal staff, internal departments, and network providers to ensure quality performance and results for Blue Cross managed care products. Responsible for auditing all aspects of BCBSIL clinical quality improvement projects and evaluating PCP compliance with BCBSIL clinical practice guidelines. Also responsible for data analysis, interaction with providers practices to educate on HEDIS measures, gaps in care and quality programs. Translate data into actionable information and determine areas for improvements as well as help implement actions toward improvement and report results to internal and external customers.
Responsibilities
The CQRA position is an integral role with BCBSIL Quality initiatives and outcomes. This role would be attractive to clinicians new to health plan quality with a desire to expand their understanding of quality programs and reporting with a focus on HEDIS /QRS and Health Plan accreditation. The CQRA's primary responsibilities include managing the Quality of Care Complaints, supporting the annual HEDIS /QRS surveys, Quality Improvement Fund project quality abstractions and overreads as well as quality reporting.
The Quality Improvement team falls under the umbrella of Network Clinical Programs and Oversight working collaboratively with BCBSIL medical directors, cross functional teams and Illinois delegated medical groups to influence clinical quality improvement and outcomes as well as support care gap closure through provider engagement, performance monitoring and incentives along with provider education across all lines of business.
Required Job Qualifications:
• Registered Nurse (RN) OR licensed clinician with current, unrestricted license in Illinois.
• Minimum of 3 years clinical practice experience performing medical record review.
• Minimum of 3 years Healthcare or Managed Care experience, including quality improvement and/or project management experience.
• Minimum of 1 year medical record data abstraction.
• Data analysis experience, skills and knowledge of statistical analysis software, and statistical methods and meaning knowledge.
• Ability to adapt to changing priorities and managing a wide range of quality projects.
• Able and willing to travel.
• Verbal and written communication skills.
• Problem resolution skills and ability to work with difficult situations with respect and diplomacy Presentation planning and delivery experience for provider training.
• Preferred Job Qualifications:
• Working knowledge of managed care programs and NCQA Accreditation guidelines.
• Project management experience and skills. QSHR and Epic experience
Sign on Bonus $5,000
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
HCSC Employment Statement:
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status Show more details...
via Chicago, IL - Geebo
posted_at: 4 days agoschedule_type: Full-timesalary: 20–28 an hour
Job Purpose:
BCBSIL has an exciting and highly impactful opportunity for a Finance Principal - responsible for helping maintain and grow BCBSIL's market share and find cost opportunities as well as potential new revenue streams. This individual contributor position will ensure continued successful fulfillment of BCBSIL's core strategies, including but not limited to developing corporate strategic... plans, communication strategies, and defining metrics
Job Purpose:
BCBSIL has an exciting and highly impactful opportunity for a Finance Principal - responsible for helping maintain and grow BCBSIL's market share and find cost opportunities as well as potential new revenue streams. This individual contributor position will ensure continued successful fulfillment of BCBSIL's core strategies, including but not limited to developing corporate strategic... plans, communication strategies, and defining metrics for success. This is a cross-functional role, so strong collaboration and communication skills are a must - across all departments especially finance (Actuarial and Underwriting), Sales and Account Management among others and requires critical thinking as well as strong execution skills. This position will make a difference across BCBSIL and have an impact on millions of members! Required Job
Qualifications:
Bachelor Degree in Actuarial Science, Mathematics, Statistics or Economics, or related fields. Other Bachelor Degrees may be considered. Minimum 7 years of experience in health care services, statistical analysis, financial analysis, financial consulting or insurance industry economics including 4 years experience in data analysis and information reporting relating to healthcare data. Advanced PC proficiency to include Word, Excel, PowerPoint or similar. Proficiency in designing reports. Excellent verbal and written communications skills to prepare effective documentation, facilitate training and development, and participate in presentations. Experience working cross-functionally within all levels of the organization, leading projects and in problem resolution. Experience in developing, maintaining and leveraging collaborative relationships with internal and external stakeholders and business leaders, to accept recommendations, cooperate or change their behavior, facilitating the accomplishment of business goals. Negotiation and influencing skills. Preferred Job
Qualifications:
MBA or MPA Experience in consulting for or working with health products and services or benefits consulting Health insurance/payer knowledge
Salary Range:
$100K -- $150K
Minimum Qualification
Corporate Finance, Healthcare ManagementEstimated Salary: $20 to $28 per hour based on qualifications Show more details...
BCBSIL has an exciting and highly impactful opportunity for a Finance Principal - responsible for helping maintain and grow BCBSIL's market share and find cost opportunities as well as potential new revenue streams. This individual contributor position will ensure continued successful fulfillment of BCBSIL's core strategies, including but not limited to developing corporate strategic... plans, communication strategies, and defining metrics for success. This is a cross-functional role, so strong collaboration and communication skills are a must - across all departments especially finance (Actuarial and Underwriting), Sales and Account Management among others and requires critical thinking as well as strong execution skills. This position will make a difference across BCBSIL and have an impact on millions of members! Required Job
Qualifications:
Bachelor Degree in Actuarial Science, Mathematics, Statistics or Economics, or related fields. Other Bachelor Degrees may be considered. Minimum 7 years of experience in health care services, statistical analysis, financial analysis, financial consulting or insurance industry economics including 4 years experience in data analysis and information reporting relating to healthcare data. Advanced PC proficiency to include Word, Excel, PowerPoint or similar. Proficiency in designing reports. Excellent verbal and written communications skills to prepare effective documentation, facilitate training and development, and participate in presentations. Experience working cross-functionally within all levels of the organization, leading projects and in problem resolution. Experience in developing, maintaining and leveraging collaborative relationships with internal and external stakeholders and business leaders, to accept recommendations, cooperate or change their behavior, facilitating the accomplishment of business goals. Negotiation and influencing skills. Preferred Job
Qualifications:
MBA or MPA Experience in consulting for or working with health products and services or benefits consulting Health insurance/payer knowledge
Salary Range:
$100K -- $150K
Minimum Qualification
Corporate Finance, Healthcare ManagementEstimated Salary: $20 to $28 per hour based on qualifications Show more details...
via The Muse
posted_at: 5 days agoschedule_type: Full-time
At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.
Come join us and be part of a purpose driven company who is invested in your future...
Job Summary
Bilingual (English and Spanish)
Responsible For Being A Compassionate And Dedicated Advocate For The Visitor
At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.
Come join us and be part of a purpose driven company who is invested in your future...
Job Summary
Bilingual (English and Spanish)
Responsible For Being A Compassionate And Dedicated Advocate For The Visitor To Demonstrate A Concierge Attitude When Assisting Visitors With Maximizing Their Benefits, Navigating The Healthcare System And Reaching Their Optimal Health. Responsible For Providing Guidance And Answering Questions From Visitors Who Visit The Center About Their Benefits And Medical Claims, As Well As Educating Visitors About Health And Wellness Programs. Assisting Visitors In Assessing Tools Available To Help Guide And Inform Decision-Making About Complex Matters Related To Their Health And Well-Being. The Incumbent Is A Subject Matter Expert And May Handle Projects And Assist With Training Others.
Required Job Qualifications:
Associate degree and 3 years of concierge oriented customer service experience OR Bachelor degree and 2 years of concierge oriented customer service experience OR 4 years of concierge oriented customer service experience.
Knowledge of HCSC customer service systems, processes, and products of the operational area.
Knowledge of medical terminology.
Experience building trust and providing concierge level of service.
Attention to detail and strong documentation skills.
Web and PC proficiency.
Preferred Job Qualifications:
Associate degree in Health Science or Health Studies or Bachelor degree.
3 years of concierge oriented customer service experience in an insurance environment, preferably with BCBSIL.
Clinical or social work expertise.
Experience in coordinating medical services.
Knowledge with health benefit plans and the insurance industry.
Bilingual in verbal and written communication: Spanish and English
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
HCSC Employment Statement:
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status Show more details...
Come join us and be part of a purpose driven company who is invested in your future...
Job Summary
Bilingual (English and Spanish)
Responsible For Being A Compassionate And Dedicated Advocate For The Visitor To Demonstrate A Concierge Attitude When Assisting Visitors With Maximizing Their Benefits, Navigating The Healthcare System And Reaching Their Optimal Health. Responsible For Providing Guidance And Answering Questions From Visitors Who Visit The Center About Their Benefits And Medical Claims, As Well As Educating Visitors About Health And Wellness Programs. Assisting Visitors In Assessing Tools Available To Help Guide And Inform Decision-Making About Complex Matters Related To Their Health And Well-Being. The Incumbent Is A Subject Matter Expert And May Handle Projects And Assist With Training Others.
Required Job Qualifications:
Associate degree and 3 years of concierge oriented customer service experience OR Bachelor degree and 2 years of concierge oriented customer service experience OR 4 years of concierge oriented customer service experience.
Knowledge of HCSC customer service systems, processes, and products of the operational area.
Knowledge of medical terminology.
Experience building trust and providing concierge level of service.
Attention to detail and strong documentation skills.
Web and PC proficiency.
Preferred Job Qualifications:
Associate degree in Health Science or Health Studies or Bachelor degree.
3 years of concierge oriented customer service experience in an insurance environment, preferably with BCBSIL.
Clinical or social work expertise.
Experience in coordinating medical services.
Knowledge with health benefit plans and the insurance industry.
Bilingual in verbal and written communication: Spanish and English
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
HCSC Employment Statement:
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status Show more details...
via The Muse
schedule_type: Full-time
At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.
Come join us and be part of a purpose driven company who is invested in your future...
Job Summary
Under supervision, this position is responsible for working on the phone all day in a call center to assist
At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.
Come join us and be part of a purpose driven company who is invested in your future...
Job Summary
Under supervision, this position is responsible for working on the phone all day in a call center to assist members and physicians by responding to telephone and written inquiries in a prompt, accurate and objective manner. Duties include: conducting research; spends approximately 90% of the scheduled time on the phone according to business need.
JOB REQUIREMENTS:
High school diploma OR GED.
6 months customer service experience OR 6 months experience in an office environment.
Data entry and/or typing experience.
Interpersonal, verbal and written communication skills.
Analytical and organizational skills and independent decision making skills.
Ability to spend approximately 90% of the scheduled time on the phone according to business needs and sit for long periods of time with scheduled breaks.
PREFERRED JOB REQUIREMENTS:
9 months customer service experience.
Experience working with various lines of business, i.e. CDHP, Medicare, Wellness, and Disease Management.
Knowledge of medical terminology and anatomy.
Proven ability to learn quickly and adapt to change.
• Referral preference given to applicants able to take and meet testing criteria.
Starting pay for the Customer Advocate I role is $17/hr with multiple openings
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
HCSC Employment Statement:
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status Show more details...
Come join us and be part of a purpose driven company who is invested in your future...
Job Summary
Under supervision, this position is responsible for working on the phone all day in a call center to assist members and physicians by responding to telephone and written inquiries in a prompt, accurate and objective manner. Duties include: conducting research; spends approximately 90% of the scheduled time on the phone according to business need.
JOB REQUIREMENTS:
High school diploma OR GED.
6 months customer service experience OR 6 months experience in an office environment.
Data entry and/or typing experience.
Interpersonal, verbal and written communication skills.
Analytical and organizational skills and independent decision making skills.
Ability to spend approximately 90% of the scheduled time on the phone according to business needs and sit for long periods of time with scheduled breaks.
PREFERRED JOB REQUIREMENTS:
9 months customer service experience.
Experience working with various lines of business, i.e. CDHP, Medicare, Wellness, and Disease Management.
Knowledge of medical terminology and anatomy.
Proven ability to learn quickly and adapt to change.
• Referral preference given to applicants able to take and meet testing criteria.
Starting pay for the Customer Advocate I role is $17/hr with multiple openings
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
HCSC Employment Statement:
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status Show more details...
via LinkedIn
schedule_type: Full-time
At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.
Come join us and be part of a purpose driven company who is invested in your future...
Job Summary
Under supervision, this position is responsible for working on the phone all day in a call center to assist
At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.
Come join us and be part of a purpose driven company who is invested in your future...
Job Summary
Under supervision, this position is responsible for working on the phone all day in a call center to assist members and physicians by responding to telephone and written inquiries in a prompt, accurate and objective manner. Duties include: conducting research; spends approximately 90% of the scheduled time on the phone according to business need.
JOB REQUIREMENTS:
• High school diploma OR GED.
• 6 months customer service experience OR 6 months experience in an office environment.
• Data entry and/or typing experience.
• Interpersonal, verbal and written communication skills.
• Analytical and organizational skills and independent decision making skills.
• Ability to spend approximately 90% of the scheduled time on the phone according to business needs and sit for long periods of time with scheduled breaks.
PREFERRED JOB REQUIREMENTS:
• 9 months customer service experience.
• Experience working with various lines of business, i.e. CDHP, Medicare, Wellness, and Disease Management.
• Knowledge of medical terminology and anatomy.
• Proven ability to learn quickly and adapt to change.
• Referral preference given to applicants able to take and meet testing criteria.
• Starting Pay for this role is $17.00 per hour
• $1500 Sign-On Bonus – $500 paid at 6 weeks and $1000 paid at 4 months of employment. Current employees are not eligible
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
HCSC Employment Statement:
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status Show more details...
Come join us and be part of a purpose driven company who is invested in your future...
Job Summary
Under supervision, this position is responsible for working on the phone all day in a call center to assist members and physicians by responding to telephone and written inquiries in a prompt, accurate and objective manner. Duties include: conducting research; spends approximately 90% of the scheduled time on the phone according to business need.
JOB REQUIREMENTS:
• High school diploma OR GED.
• 6 months customer service experience OR 6 months experience in an office environment.
• Data entry and/or typing experience.
• Interpersonal, verbal and written communication skills.
• Analytical and organizational skills and independent decision making skills.
• Ability to spend approximately 90% of the scheduled time on the phone according to business needs and sit for long periods of time with scheduled breaks.
PREFERRED JOB REQUIREMENTS:
• 9 months customer service experience.
• Experience working with various lines of business, i.e. CDHP, Medicare, Wellness, and Disease Management.
• Knowledge of medical terminology and anatomy.
• Proven ability to learn quickly and adapt to change.
• Referral preference given to applicants able to take and meet testing criteria.
• Starting Pay for this role is $17.00 per hour
• $1500 Sign-On Bonus – $500 paid at 6 weeks and $1000 paid at 4 months of employment. Current employees are not eligible
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
HCSC Employment Statement:
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status Show more details...
via Salary.com
schedule_type: Full-time
At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.
Come join us and be part of a purpose driven company who is invested in your future...
Job Summary
This position is responsible for developing and maintaining cooperative working relationships with the contracting
At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.
Come join us and be part of a purpose driven company who is invested in your future...
Job Summary
This position is responsible for developing and maintaining cooperative working relationships with the contracting provider community. Responsible for educating, training, researching problems, identifying trends and evaluating providers to ensure that all contractual and financial requirements are adhered to and performed. Ability and willingness to travel, including overnight stays.
Job Responsibilities:
• Establishes and maintains relationships between Blue Cross and its providers to promote and ensure that BCBSIL networks are cost effective and quality driven.
• Performs physician contracting responsibilities for the PPO and POS products, special groups within other managed care products, and the downstate region. Coordinates and participates in the drafting and interpretation of contracts and agreements. Enforces negotiated terms.
• Coordinates and participates in the preparation of benefit descriptions for use by Actuarial and Marketing Departments, and assists SSD and Medical Management in the adjudication of claims through PMCI, Real Med, and Thin Online.
• Relates critical competitive information to Senior Management to initiate a Corporate reaction which directly affects Blue Cross policies and our stability in the Managed Care market.
• Provides consultation to providers regarding independent decisions for all aspects of their operations, including financial reimbursement, policies, procedures, and contractual issues.
• Maintains a thorough level of knowledge for all lines of business (HMO, Blue Choice, Blue Advantage, etc.) to ensure provider contract compliance. Performs investigative research upon the request of providers regarding the intricate and detailed information for all lines of business.
• Assists in conducting seminars and presentations for outside organizations including HFMA, MCHC, Chicago Medical Society, AGPAM, and IHA with attendance from 2-300. Acts as BCBSIL representative at related activities.
• Maintains a thorough level of knowledge regarding all provider related systems including Blue Chip, FSSO, HIQA, HMO, SI-RHIN, EFT, ERA, as well as NASCO, FEP, and ITS (BlueCard).
• Provides training and education to all Blue Cross contracting providers including hospitals, physicians, free-standing surgery centers, free standing substance abuse facilities, free standing psych facilities, VA hospitals, and all other allied professional providers.
• Provides valuable feedback to the Group Markets Division regarding potential positive and negative issues.
• Maintains high profile with internal senior staff to resolve discrepancies and errors that have occurred between the providers and SSD, GCS, Audit, and Cash Disbursements
Required Job Qualifications:
• Bachelor's degree in health care or business administration or a minimum of 4 years work experience in a managed care environment.
• Minimum of 2 years of health care administration experience in clinical and financial settings, with direct provider communication experience.
• Effective interpersonal, analytical, presentation and communication skills.
• Knowledge of the health care industry and BCBSIL private business.
• Ability and willingness to travel within assigned areas for responsibility, including overnight stays.
• Extensive knowledge of contracts, applications, and products.
• Demonstrated proficiency in provider reimbursement methods.
• Working knowledge of claims processing systems.
• Effective organizational and planning skills.
• Ability to take initiative and work independently.
• Demonstrated ability to meet deadlines and work well under pressure.
• Working knowledge of software, including Microsoft Office
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
HCSC Employment Statement:
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
BCBSTX complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex Show more details...
Come join us and be part of a purpose driven company who is invested in your future...
Job Summary
This position is responsible for developing and maintaining cooperative working relationships with the contracting provider community. Responsible for educating, training, researching problems, identifying trends and evaluating providers to ensure that all contractual and financial requirements are adhered to and performed. Ability and willingness to travel, including overnight stays.
Job Responsibilities:
• Establishes and maintains relationships between Blue Cross and its providers to promote and ensure that BCBSIL networks are cost effective and quality driven.
• Performs physician contracting responsibilities for the PPO and POS products, special groups within other managed care products, and the downstate region. Coordinates and participates in the drafting and interpretation of contracts and agreements. Enforces negotiated terms.
• Coordinates and participates in the preparation of benefit descriptions for use by Actuarial and Marketing Departments, and assists SSD and Medical Management in the adjudication of claims through PMCI, Real Med, and Thin Online.
• Relates critical competitive information to Senior Management to initiate a Corporate reaction which directly affects Blue Cross policies and our stability in the Managed Care market.
• Provides consultation to providers regarding independent decisions for all aspects of their operations, including financial reimbursement, policies, procedures, and contractual issues.
• Maintains a thorough level of knowledge for all lines of business (HMO, Blue Choice, Blue Advantage, etc.) to ensure provider contract compliance. Performs investigative research upon the request of providers regarding the intricate and detailed information for all lines of business.
• Assists in conducting seminars and presentations for outside organizations including HFMA, MCHC, Chicago Medical Society, AGPAM, and IHA with attendance from 2-300. Acts as BCBSIL representative at related activities.
• Maintains a thorough level of knowledge regarding all provider related systems including Blue Chip, FSSO, HIQA, HMO, SI-RHIN, EFT, ERA, as well as NASCO, FEP, and ITS (BlueCard).
• Provides training and education to all Blue Cross contracting providers including hospitals, physicians, free-standing surgery centers, free standing substance abuse facilities, free standing psych facilities, VA hospitals, and all other allied professional providers.
• Provides valuable feedback to the Group Markets Division regarding potential positive and negative issues.
• Maintains high profile with internal senior staff to resolve discrepancies and errors that have occurred between the providers and SSD, GCS, Audit, and Cash Disbursements
Required Job Qualifications:
• Bachelor's degree in health care or business administration or a minimum of 4 years work experience in a managed care environment.
• Minimum of 2 years of health care administration experience in clinical and financial settings, with direct provider communication experience.
• Effective interpersonal, analytical, presentation and communication skills.
• Knowledge of the health care industry and BCBSIL private business.
• Ability and willingness to travel within assigned areas for responsibility, including overnight stays.
• Extensive knowledge of contracts, applications, and products.
• Demonstrated proficiency in provider reimbursement methods.
• Working knowledge of claims processing systems.
• Effective organizational and planning skills.
• Ability to take initiative and work independently.
• Demonstrated ability to meet deadlines and work well under pressure.
• Working knowledge of software, including Microsoft Office
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
HCSC Employment Statement:
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
BCBSTX complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex Show more details...
via Glassdoor
posted_at: 3 days agoschedule_type: Full-time
At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.
Come join us and be part of a purpose driven company who is invested in your future...
Job Summary
This position is responsible for acting as a lead individual contributor within the Illinois Contract Administration
At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.
Come join us and be part of a purpose driven company who is invested in your future...
Job Summary
This position is responsible for acting as a lead individual contributor within the Illinois Contract Administration department, working to establish and maintain relationships with BCBSIL’s largest healthcare providers by project managing all initiatives relevant to these providers. Additionally, this position is responsible for driving key initiatives and contracting that materially advance the productivity of the network management team, including supporting special initiatives and projects, providing support and leadership for quality improvement initiatives, reporting and analysis, network adequacy requirements, provider contract execution, and acting as a product owner and key business stakeholder to ensure continuity of deliverables to stakeholders across HCSC.
Responsibilities
Required Job Qualifications:
Bachelor degree and 4 years health insurance contract operations experience OR 8 years of relevant experience OR Master degree with 2 years health insurance contact operations experience.
Knowledge of health products and procedures, underwriting requirements, contract and funding arrangements.
Analytical and reporting skills.
PC proficiency to include Microsoft Office Suite.
Project management skills.
Customer service experience and acumen.
Leadership skills.
Verbal and written communications skills to manage staff and operations, build relationships across the organization and with external key stakeholders, build consensus and issue resolution.
Preferred Job Qualifications:
Experience working as an account manager or supporting account managers around large complex contract negotiations.
Management consulting experience.
Process improvement skillset and acumen.
Experience working in a matrixed environment.
Software development or business analysis experience.
Knowledge of external adjudication processes.
Knowledge of large or national account contract specifications and processing systems.
Knowledge of health insurance product lines.
Knowledge of network contracting and contracting system (Apttus) including contract performance, interpretation and application of findings to contracts, and contract structure and financial impact.
We encourage people of all backgrounds and experiences to apply.
Even if you don’t think you are a perfect fit, apply anyway - you might have qualifications we haven’t even thought of yet.
#LI-Hybrid
#LI-RV1
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
HCSC Employment Statement:
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status Show more details...
Come join us and be part of a purpose driven company who is invested in your future...
Job Summary
This position is responsible for acting as a lead individual contributor within the Illinois Contract Administration department, working to establish and maintain relationships with BCBSIL’s largest healthcare providers by project managing all initiatives relevant to these providers. Additionally, this position is responsible for driving key initiatives and contracting that materially advance the productivity of the network management team, including supporting special initiatives and projects, providing support and leadership for quality improvement initiatives, reporting and analysis, network adequacy requirements, provider contract execution, and acting as a product owner and key business stakeholder to ensure continuity of deliverables to stakeholders across HCSC.
Responsibilities
Required Job Qualifications:
Bachelor degree and 4 years health insurance contract operations experience OR 8 years of relevant experience OR Master degree with 2 years health insurance contact operations experience.
Knowledge of health products and procedures, underwriting requirements, contract and funding arrangements.
Analytical and reporting skills.
PC proficiency to include Microsoft Office Suite.
Project management skills.
Customer service experience and acumen.
Leadership skills.
Verbal and written communications skills to manage staff and operations, build relationships across the organization and with external key stakeholders, build consensus and issue resolution.
Preferred Job Qualifications:
Experience working as an account manager or supporting account managers around large complex contract negotiations.
Management consulting experience.
Process improvement skillset and acumen.
Experience working in a matrixed environment.
Software development or business analysis experience.
Knowledge of external adjudication processes.
Knowledge of large or national account contract specifications and processing systems.
Knowledge of health insurance product lines.
Knowledge of network contracting and contracting system (Apttus) including contract performance, interpretation and application of findings to contracts, and contract structure and financial impact.
We encourage people of all backgrounds and experiences to apply.
Even if you don’t think you are a perfect fit, apply anyway - you might have qualifications we haven’t even thought of yet.
#LI-Hybrid
#LI-RV1
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
HCSC Employment Statement:
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status Show more details...
via LinkedIn
posted_at: 4 days agoschedule_type: Full-time
At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.
Come join us and be part of a purpose driven company who is invested in your future...
Job Summary
As a member of HCSC’s Data & Analytics Solutions (DAS) division, this individual will lead data solution
At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.
Come join us and be part of a purpose driven company who is invested in your future...
Job Summary
As a member of HCSC’s Data & Analytics Solutions (DAS) division, this individual will lead data solution analyst tasks for multiple programs. This position is part of a data product team; and will allow you to utilize and expand your skills for designing enhancements and new business applications and/or data solutions through integration of technical and business requirements; serving as technical designer to identify best solution and resulting technical data specifications; linking Business Analyst needs and Architect definition to integrated data solutions.
Responsibilities (including but not limited to):
• Serve as a lead and subject matter expert for product owned data solutions
• Work with business and coordinate with other analysts and product team members to document required integrated data solutions
• Complete source to target mapping documents for various data integration projects
• Support design and implementation of data integrations for your data product team
• Own mapping documents and data lineage for core data product capabilities and features
• Partner with vendors, data governance teams, other product teams to ensure integrity of data product is maintained year over year
• Support and maintain Data & Analytics product processes from both a technical and business perspective
• Support technical data analysis tasks for data product and business stakeholders
• Serve as a core member of your product team and valued member of the Data & Analytics organization
Qualifications:
• Bachelor Degree in Computer Science or Information Technology or Information Studies related field and 2-4 years Data & Analytics experience
• Experience in database platforms such as Teradata, Hadoop, Azure, AWS, etc.
• Experience in integration technologies such as DataStage, Talend, Informatica, Kafka, etc.
• Experience in written languages such as SQL, Python, Spark, etc.
• Experience in database configuration and database modeling concepts
• Strong experience in Source to Target data mapping
• Experience in requirements definition & technical interpretation
• Knowledge of SDLC methodology - Agile / Scrum / Iterative Development
• Strong problem solving and analytical thinking skills
• Strong oral/written communication skills
• Strong collaborative product mindset
Desired skills:
• Understanding of other cloud service provider offerings including Azure/AWS
• Experience with Microsoft Synapse or other Microsoft suite of tools on cloud
• Experience with Teradata
• Excellent written, verbal, and meeting facilitation skills
__________________________________________________________________________________________________
Required Job Qualifications Bachelor Degree and 2 years Information Technology OR Technical Certification and/or College Courses and 4 year Information Technology experience OR 6 years Information Technology experience. * Knowledge of application configuration * Knowledge of Big Data Analytics - HAVeN / HADOOP/ Autonomy / Vertica * Knowledge of Cloud computing / SaaS / IaaS / PaaS technologies * Knowledge of Integration Technologies - Tibco/Informatica/CAS * Knowledge of Mobile technologies - Phonegap / iOS / Android / Java / HTML5 * Knowledge of Scripting Languages - BASH / PERL / PYTHON / RUBY * Service Oriented Architecture - SOAP / REST * Web Technologies - HTML/CSS/Java/ASP.Net/PHP/Ruby/C# * Rapid prototyping * Requirements definition & management * SDLC Methodology - Agile / Scrum / Iterative Development * System Performance management * Conceptual thinking * Creative thinking * Problem solving and analytical thinking * Strong oral/written communication skills Preferred Job Qualifications: * Bachelor Degree in Computer Science or Information Technology related * Ability to execute
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
HCSC Employment Statement:
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status Show more details...
Come join us and be part of a purpose driven company who is invested in your future...
Job Summary
As a member of HCSC’s Data & Analytics Solutions (DAS) division, this individual will lead data solution analyst tasks for multiple programs. This position is part of a data product team; and will allow you to utilize and expand your skills for designing enhancements and new business applications and/or data solutions through integration of technical and business requirements; serving as technical designer to identify best solution and resulting technical data specifications; linking Business Analyst needs and Architect definition to integrated data solutions.
Responsibilities (including but not limited to):
• Serve as a lead and subject matter expert for product owned data solutions
• Work with business and coordinate with other analysts and product team members to document required integrated data solutions
• Complete source to target mapping documents for various data integration projects
• Support design and implementation of data integrations for your data product team
• Own mapping documents and data lineage for core data product capabilities and features
• Partner with vendors, data governance teams, other product teams to ensure integrity of data product is maintained year over year
• Support and maintain Data & Analytics product processes from both a technical and business perspective
• Support technical data analysis tasks for data product and business stakeholders
• Serve as a core member of your product team and valued member of the Data & Analytics organization
Qualifications:
• Bachelor Degree in Computer Science or Information Technology or Information Studies related field and 2-4 years Data & Analytics experience
• Experience in database platforms such as Teradata, Hadoop, Azure, AWS, etc.
• Experience in integration technologies such as DataStage, Talend, Informatica, Kafka, etc.
• Experience in written languages such as SQL, Python, Spark, etc.
• Experience in database configuration and database modeling concepts
• Strong experience in Source to Target data mapping
• Experience in requirements definition & technical interpretation
• Knowledge of SDLC methodology - Agile / Scrum / Iterative Development
• Strong problem solving and analytical thinking skills
• Strong oral/written communication skills
• Strong collaborative product mindset
Desired skills:
• Understanding of other cloud service provider offerings including Azure/AWS
• Experience with Microsoft Synapse or other Microsoft suite of tools on cloud
• Experience with Teradata
• Excellent written, verbal, and meeting facilitation skills
__________________________________________________________________________________________________
Required Job Qualifications Bachelor Degree and 2 years Information Technology OR Technical Certification and/or College Courses and 4 year Information Technology experience OR 6 years Information Technology experience. * Knowledge of application configuration * Knowledge of Big Data Analytics - HAVeN / HADOOP/ Autonomy / Vertica * Knowledge of Cloud computing / SaaS / IaaS / PaaS technologies * Knowledge of Integration Technologies - Tibco/Informatica/CAS * Knowledge of Mobile technologies - Phonegap / iOS / Android / Java / HTML5 * Knowledge of Scripting Languages - BASH / PERL / PYTHON / RUBY * Service Oriented Architecture - SOAP / REST * Web Technologies - HTML/CSS/Java/ASP.Net/PHP/Ruby/C# * Rapid prototyping * Requirements definition & management * SDLC Methodology - Agile / Scrum / Iterative Development * System Performance management * Conceptual thinking * Creative thinking * Problem solving and analytical thinking * Strong oral/written communication skills Preferred Job Qualifications: * Bachelor Degree in Computer Science or Information Technology related * Ability to execute
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
HCSC Employment Statement:
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status Show more details...
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