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via Working At Blue Cross And Blue Shield Of Minnesota
posted_at: 2 days agoschedule_type: Full-time
About Blue Cross
Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We’re committed to reinventing health care to improve health for our members and the community. We hope you'll join us...
How Is This Role Important to Our Work?
This position is responsible for activities associated with the credentialing process and completing the set-up and maintenance
About Blue Cross
Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We’re committed to reinventing health care to improve health for our members and the community. We hope you'll join us...
How Is This Role Important to Our Work?
This position is responsible for activities associated with the credentialing process and completing the set-up and maintenance of practitioner and provider information on the provider databases. These activities will adhere to regulatory agency credentialing requirements, such as NCQA, Dept of Health, Medicare and Blue Cross Blue Shield Association
A Day in the Life:
• Resolve credentialing status by screening and assessing all credentialing materials.
• Research, analyze and process routine credentialing cases.
• Set up and maintain accurate provider and practitioner information on the provider databases, which are used for consumer initiatives with Blue Cross.
• Respond to customers regarding provider and practitioner eligibility and credentialing decisions and/or related issues.
• Maintain credentialing quality and production performance metrics.
• Support process improvements to ensure an efficient operation.
• Special projects as assigned.
Required Skills and Experiences:
• 4+ years of related experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• 1 year experience in the area of Provider Credentialing
• Ability to prioritize multiple tasks or projects.
• Detailed with a quality focus.
• Ability to work independently and demonstrate problem-solving skills.
Make A Difference
Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.
Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.
All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.
Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association Show more details...
Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We’re committed to reinventing health care to improve health for our members and the community. We hope you'll join us...
How Is This Role Important to Our Work?
This position is responsible for activities associated with the credentialing process and completing the set-up and maintenance of practitioner and provider information on the provider databases. These activities will adhere to regulatory agency credentialing requirements, such as NCQA, Dept of Health, Medicare and Blue Cross Blue Shield Association
A Day in the Life:
• Resolve credentialing status by screening and assessing all credentialing materials.
• Research, analyze and process routine credentialing cases.
• Set up and maintain accurate provider and practitioner information on the provider databases, which are used for consumer initiatives with Blue Cross.
• Respond to customers regarding provider and practitioner eligibility and credentialing decisions and/or related issues.
• Maintain credentialing quality and production performance metrics.
• Support process improvements to ensure an efficient operation.
• Special projects as assigned.
Required Skills and Experiences:
• 4+ years of related experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• 1 year experience in the area of Provider Credentialing
• Ability to prioritize multiple tasks or projects.
• Detailed with a quality focus.
• Ability to work independently and demonstrate problem-solving skills.
Make A Difference
Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.
Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.
All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.
Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association Show more details...
via Working At Blue Cross And Blue Shield Of Minnesota
schedule_type: Full-time
About Blue Cross
Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We’re committed to reinventing health care to improve health for our members and the community. We hope you'll join us...
How Is This Role Important to Our Work?
The Systems Engineer is responsible for the execution of standards and guidelines that drive the design of technology solutions
About Blue Cross
Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We’re committed to reinventing health care to improve health for our members and the community. We hope you'll join us...
How Is This Role Important to Our Work?
The Systems Engineer is responsible for the execution of standards and guidelines that drive the design of technology solutions including implementing solutions requiring integration of multiple platforms, operating systems, servers and applications across the enterprise. Performs analysis and evaluation of customer technical and analytical requirements. Plans, develops, tests and documents systems and provides follow up to ensure success of the environment. Responsible as a technical resource in at least one critical service or technology and applies knowledge in at least one area.
A Day in the Life:
• Conducts detailed analysis and study of customer requirements for new or existing projects to determine feasibility, cost and time required, and compatibility with current systems and hardware capabilities.
• Develops and documents the framework for integration and implementation for changes to technical standards.
• Develops moderate to complex infrastructure interactions to ensure the security, stability, recoverability, and access to systems and information.
• Participates in cross-functional initiatives on the development and implementation of enterprise-wide major installations, upgrades and process changes.
• Facilitates knowledge sharing by creating and maintaining detailed, comprehensive documentation and diagrams.
• Provides technical guidance to others as appropriate.
• Tracks industry trends and maintains knowledge of new technologies to better serve the enterprise architecture needs.
• Performs systems support activities and may include required participation in an on-call rotation for support of systems outside of normal business hours.
• Participates in structured cross-functional processes including architecture, change, risk, resiliency, incident, problem, CMDB, and asset management.
Nice to Have:
• Bachelor's degree.
• Knowledge of BCBS computer methodologies.
• Advanced knowledge of multiple business areas.
• Technical Certification.
Required Skills and Experiences:
• 3+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• Demonstrated knowledge of infrastructure design, implementation, administration, planning, developing Demonstrated knowledge of technical, business, and industry.
• Strong oral and written communication and presentation skills.
• Strong human relations skills to effectively interact with leadership and management, peers, business partners and vendors.
• Skilled at systems, creative, critical and analytical thinking, decision making and problem solving.
• Demonstrated understanding of the standards and deliverables to ensure integrity of the systems engineering process.
• Knowledge of internal area applications.
• Demonstrated skills at hands-on communication, collaboration and leadership.
• Skilled at influencing and motivating individuals and teams.
Make A Difference
Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.
Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.
All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.
Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association Show more details...
Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We’re committed to reinventing health care to improve health for our members and the community. We hope you'll join us...
How Is This Role Important to Our Work?
The Systems Engineer is responsible for the execution of standards and guidelines that drive the design of technology solutions including implementing solutions requiring integration of multiple platforms, operating systems, servers and applications across the enterprise. Performs analysis and evaluation of customer technical and analytical requirements. Plans, develops, tests and documents systems and provides follow up to ensure success of the environment. Responsible as a technical resource in at least one critical service or technology and applies knowledge in at least one area.
A Day in the Life:
• Conducts detailed analysis and study of customer requirements for new or existing projects to determine feasibility, cost and time required, and compatibility with current systems and hardware capabilities.
• Develops and documents the framework for integration and implementation for changes to technical standards.
• Develops moderate to complex infrastructure interactions to ensure the security, stability, recoverability, and access to systems and information.
• Participates in cross-functional initiatives on the development and implementation of enterprise-wide major installations, upgrades and process changes.
• Facilitates knowledge sharing by creating and maintaining detailed, comprehensive documentation and diagrams.
• Provides technical guidance to others as appropriate.
• Tracks industry trends and maintains knowledge of new technologies to better serve the enterprise architecture needs.
• Performs systems support activities and may include required participation in an on-call rotation for support of systems outside of normal business hours.
• Participates in structured cross-functional processes including architecture, change, risk, resiliency, incident, problem, CMDB, and asset management.
Nice to Have:
• Bachelor's degree.
• Knowledge of BCBS computer methodologies.
• Advanced knowledge of multiple business areas.
• Technical Certification.
Required Skills and Experiences:
• 3+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• Demonstrated knowledge of infrastructure design, implementation, administration, planning, developing Demonstrated knowledge of technical, business, and industry.
• Strong oral and written communication and presentation skills.
• Strong human relations skills to effectively interact with leadership and management, peers, business partners and vendors.
• Skilled at systems, creative, critical and analytical thinking, decision making and problem solving.
• Demonstrated understanding of the standards and deliverables to ensure integrity of the systems engineering process.
• Knowledge of internal area applications.
• Demonstrated skills at hands-on communication, collaboration and leadership.
• Skilled at influencing and motivating individuals and teams.
Make A Difference
Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.
Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.
All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.
Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association Show more details...
via Working At Blue Cross And Blue Shield Of Minnesota
schedule_type: Full-time
About Blue Cross
Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We’re committed to reinventing health care to improve health for our members and the community. We hope you'll join us...
How is This Role Important to Our Work?
We are looking for a passionate, hard-working Salesforce Consultant who can help us build innovative technology experiences that
About Blue Cross
Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We’re committed to reinventing health care to improve health for our members and the community. We hope you'll join us...
How is This Role Important to Our Work?
We are looking for a passionate, hard-working Salesforce Consultant who can help us build innovative technology experiences that will support BlueCross’s mission to inspire change, transform care and improve health for the people we serve.
A Day in the Life:
• Analyze, design, configure, debug, maintain new or existing Salesforce systems.
• Work collaboratively on a daily scrum team with a scrum master, product owner, analysts, developers, and testers to iteratively deliver functional software to production.
• Provide leadership for projects and products to ensure usability, usefulness, feasibility, and cost effectiveness.
• Work with analysts and customers to establish product or project requirements.
• Contribute innovative solutions while utilizing best practices, design standards, and governance.
• Perform system administration activities including data loading, data migration/conversion, data clean-up tasks, system integration monitoring, etc.
• Research technology trends and contribute to designs and platform decisions.
• Mentor, lead, train other team members.
• This job may include on-call duties.
Required Skills and Experiences:
• 7+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• Essential Candidate Qualities: Creative thinking, strong communication skills, creativity, curiosity, self-motivated, time managements skills
Consultant Experience:
• 5+ years of admin, analyst, and/or consultant skills on Salesforce Cloud platforms
• Hands-on experience with all aspects of declarative configuration methods (such as object, page, and field creation) and declarative automation methods (such as Process Builder, Flows, etc.)
• Familiarity with multi-integration org and its system impacts
• In depth prototype design and implementation experience.
• Worked in an organization of 250 or more users with experience providing user support, training, and data cleanup and/or data migration.
• Experience with: DataLoader, Jira, Salesforce automation tools, Apex, JSON
• Knowledge of out-of-the-box functionality
Nice to Have:
• Bachelor’s Degree
• Experience with agile, DevOps, IT Service Management, and other development and support processes and methodologies.
• Salesforce Certifications: Admin I, Admin II, Advanced Admin, Platform App Builder
• Strong configuration and administration experience with Salesforce
• Knowledge, experience, and familiarity with Salesforce the ecosystem and its products
Make A Difference
Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.
Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.
All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.
Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association Show more details...
Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We’re committed to reinventing health care to improve health for our members and the community. We hope you'll join us...
How is This Role Important to Our Work?
We are looking for a passionate, hard-working Salesforce Consultant who can help us build innovative technology experiences that will support BlueCross’s mission to inspire change, transform care and improve health for the people we serve.
A Day in the Life:
• Analyze, design, configure, debug, maintain new or existing Salesforce systems.
• Work collaboratively on a daily scrum team with a scrum master, product owner, analysts, developers, and testers to iteratively deliver functional software to production.
• Provide leadership for projects and products to ensure usability, usefulness, feasibility, and cost effectiveness.
• Work with analysts and customers to establish product or project requirements.
• Contribute innovative solutions while utilizing best practices, design standards, and governance.
• Perform system administration activities including data loading, data migration/conversion, data clean-up tasks, system integration monitoring, etc.
• Research technology trends and contribute to designs and platform decisions.
• Mentor, lead, train other team members.
• This job may include on-call duties.
Required Skills and Experiences:
• 7+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• Essential Candidate Qualities: Creative thinking, strong communication skills, creativity, curiosity, self-motivated, time managements skills
Consultant Experience:
• 5+ years of admin, analyst, and/or consultant skills on Salesforce Cloud platforms
• Hands-on experience with all aspects of declarative configuration methods (such as object, page, and field creation) and declarative automation methods (such as Process Builder, Flows, etc.)
• Familiarity with multi-integration org and its system impacts
• In depth prototype design and implementation experience.
• Worked in an organization of 250 or more users with experience providing user support, training, and data cleanup and/or data migration.
• Experience with: DataLoader, Jira, Salesforce automation tools, Apex, JSON
• Knowledge of out-of-the-box functionality
Nice to Have:
• Bachelor’s Degree
• Experience with agile, DevOps, IT Service Management, and other development and support processes and methodologies.
• Salesforce Certifications: Admin I, Admin II, Advanced Admin, Platform App Builder
• Strong configuration and administration experience with Salesforce
• Knowledge, experience, and familiarity with Salesforce the ecosystem and its products
Make A Difference
Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.
Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.
All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.
Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association Show more details...
via Snagajob
posted_at: 9 hours agoschedule_type: Full-time
About Blue Cross
Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us...
How Is this Role Important to Our Work?
As a Enterprise Data Analyst, you will have the ability to manage semi-complex to complex data and information to provide meaningful
About Blue Cross
Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us...
How Is this Role Important to Our Work?
As a Enterprise Data Analyst, you will have the ability to manage semi-complex to complex data and information to provide meaningful results, which influences strategic decision-making at Blue Cross. The incumbent works both independently and with a team to plan, initiate and occasionally lead analysis from conceptual development, through the programming stage and to implementation. Responsibilities include working with customers to understand business requirements, data modeling, data management and stewardship for a variety of data sources, data analysis, data testing and the application of analytical techniques to ensure that the data is answering the right question. Besides, this position is also responsible to design, develop and maintain data visualizations using reports and dashboards. The incumbent will also be relied upon as a Business Intelligence power user and a data steward for the enterprise, providing services to a variety of customers, like Government, Network Management, Sales and Marketing, Finance, Actuary and Underwriting, Audit and the Operations Division. Business data knowledge and programming skills will be leveraged.
A Day in the Life:
• Develops plans, analyze data and report results to key internal stakeholders.
• Serves as a data and analytical consultant for key internal stakeholders.
• Designs and builds strategic and actionable insights utilizing comprehensive visual analytics capabilities.
• Prepares reports and analysis to identify and interpret trends or patterns in complex data sets for values and new opportunities.
• Serves as a data expert across a variety of legacy and contemporary data sources and is recognized as having a skill set that few within the organization have.
• Develops meaningful reporting programs in a variety of reporting and analytic tools, integrating multiple data sources together.
• Assists co-workers in using data/information in new and innovative ways.
• Interact with varying levels of leadership, including executives, to present information and provide suggestions for improving internal enterprise data sources.
• Working with associates across the organization on data sources, how to access data sources and the best source to access to meet data needs, data modeling, data management, data analysis and data testing to ensure that the data is answering the right question.
• Partners with internal customers to define business requirements at a very granular level, including understanding the question at hand, and provides the optimal data reporting solution.
Required Skills and Experiences:
• 3+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• Experience in any of the following languages and platforms: like (Microsoft BI, Power BI, SSIS, SSAS, SSRS, SAS JCL, SAS EG, SAS BI, SQL Server, Visual Basic or VIPS)
• Technical proficiency in developing reports using Power BI and other/or other reporting tools like Tableau, Cognos etc.
• Proven experience in working with customers across the enterprise to understand business questions and to develop reporting and analytical solutions in.
• Demonstrated ability to design, evaluate and interpret complex data sets.
• Strong analytic and problem-solving skills.
• Demonstrated ability to present complex technical information to non-technical audiences and executives.
• Demonstrated ability to work independently and in a team setting with individuals having diverse professional backgrounds including business, technical and /or clinical.
• Proficiency in Microsoft software application such as Word, Powerpoint, Excel, Access.
Nice to Have:
• Bachelor's degree.
• Minimum of two years applied experience in working with Visual Analytics Platforms.
• Strong visual design skills and technical proficiency in developing reports using QuickSight and/or other reporting tools.
• Knowledge of government line of business.
• Business analyst experience or proven experience in working with customers across the enterprise to understand business questions and to develop reporting and analytical solutions in support of those questions.
Role Designation:
Hybrid Remote
Role designation definition: Teleworking is working full time remote. Hybrid is a combination of working onsite and remotely. Onsite is full-time onsite.
Make a difference
Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.
Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.
All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.
Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association Show more details...
Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us...
How Is this Role Important to Our Work?
As a Enterprise Data Analyst, you will have the ability to manage semi-complex to complex data and information to provide meaningful results, which influences strategic decision-making at Blue Cross. The incumbent works both independently and with a team to plan, initiate and occasionally lead analysis from conceptual development, through the programming stage and to implementation. Responsibilities include working with customers to understand business requirements, data modeling, data management and stewardship for a variety of data sources, data analysis, data testing and the application of analytical techniques to ensure that the data is answering the right question. Besides, this position is also responsible to design, develop and maintain data visualizations using reports and dashboards. The incumbent will also be relied upon as a Business Intelligence power user and a data steward for the enterprise, providing services to a variety of customers, like Government, Network Management, Sales and Marketing, Finance, Actuary and Underwriting, Audit and the Operations Division. Business data knowledge and programming skills will be leveraged.
A Day in the Life:
• Develops plans, analyze data and report results to key internal stakeholders.
• Serves as a data and analytical consultant for key internal stakeholders.
• Designs and builds strategic and actionable insights utilizing comprehensive visual analytics capabilities.
• Prepares reports and analysis to identify and interpret trends or patterns in complex data sets for values and new opportunities.
• Serves as a data expert across a variety of legacy and contemporary data sources and is recognized as having a skill set that few within the organization have.
• Develops meaningful reporting programs in a variety of reporting and analytic tools, integrating multiple data sources together.
• Assists co-workers in using data/information in new and innovative ways.
• Interact with varying levels of leadership, including executives, to present information and provide suggestions for improving internal enterprise data sources.
• Working with associates across the organization on data sources, how to access data sources and the best source to access to meet data needs, data modeling, data management, data analysis and data testing to ensure that the data is answering the right question.
• Partners with internal customers to define business requirements at a very granular level, including understanding the question at hand, and provides the optimal data reporting solution.
Required Skills and Experiences:
• 3+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• Experience in any of the following languages and platforms: like (Microsoft BI, Power BI, SSIS, SSAS, SSRS, SAS JCL, SAS EG, SAS BI, SQL Server, Visual Basic or VIPS)
• Technical proficiency in developing reports using Power BI and other/or other reporting tools like Tableau, Cognos etc.
• Proven experience in working with customers across the enterprise to understand business questions and to develop reporting and analytical solutions in.
• Demonstrated ability to design, evaluate and interpret complex data sets.
• Strong analytic and problem-solving skills.
• Demonstrated ability to present complex technical information to non-technical audiences and executives.
• Demonstrated ability to work independently and in a team setting with individuals having diverse professional backgrounds including business, technical and /or clinical.
• Proficiency in Microsoft software application such as Word, Powerpoint, Excel, Access.
Nice to Have:
• Bachelor's degree.
• Minimum of two years applied experience in working with Visual Analytics Platforms.
• Strong visual design skills and technical proficiency in developing reports using QuickSight and/or other reporting tools.
• Knowledge of government line of business.
• Business analyst experience or proven experience in working with customers across the enterprise to understand business questions and to develop reporting and analytical solutions in support of those questions.
Role Designation:
Hybrid Remote
Role designation definition: Teleworking is working full time remote. Hybrid is a combination of working onsite and remotely. Onsite is full-time onsite.
Make a difference
Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.
Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.
All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.
Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association Show more details...
via Snagajob
posted_at: 1 day agoschedule_type: Full-time
About Blue Cross
Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us...
How Is This Role Important to Our Work?
This role is responsible for leading the day to day operational performance of a care management team while ensuring high quality
About Blue Cross
Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us...
How Is This Role Important to Our Work?
This role is responsible for leading the day to day operational performance of a care management team while ensuring high quality care management and adherence to regulatory and compliance standards for the Medicaid line of business. The manager is responsible for continued enhancements of operational effectiveness while building relationships with key internal and external stakeholders.
A Day in the Life:
• Manages and leads the overall care management activities and day to day operations of a successful member centric care management team ensuring program activity that achieves strategic goals and objectives.
• Builds a department environment and culture that creates and maintains high performing teams with strong employee engagement.
• Facilitates effective multi -disciplinary teamwork within the department to enhance member care and program performance.
• Design, develop, and implement innovative projects related to care management initiatives that may encompass cross functional and strategic partners.
• Acts as a clinical, care management, and business case consultant for leadership as they relate to case/disease/utilization management.
• Coordinates the development, revision and implementation of care management policies and procedures.
• Assures consistency in processes and function across teams auditing and solid business practices.
• Assure compliance with state and federal regulations, accreditation requirements, contract agreements, and performance guarantees and participates and/or leads with on-site account and provider meetings.
• Excellent communication with members, providers, management, and customers to facilitate success of member and program outcomes, department objectives, and corporate strategic pillars.
• Cultivates strong working relationships across the enterprise to promote successful execution of care management programs and key initiatives.
• Ability to analyze data, conduct root cause analysis, and recommend strategies for pilots, projects, and trends for care management initiatives.
• Manages the department including interviewing and hiring employees following required EEO and Affirmative Action guidelines and ensuring employees receive the proper training.
• Conducts performance evaluation, and is responsible for managing employees, including skill and career development, policy administration, coaching on performance management and behavior, employee relations and cost control.
Required Skills and Experiences:
• Current registered nurse with MN licensure in the state of MN without restrictions or pending restrictions
• 7+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• If a leader of Case Managers, CCM Certification or ability to obtain within 3 years of starting in the position is required.
• 3 years leadership experience leading people, projects, products, or operations
• Strong leadership ability to drive results and excel in a collaborative, matrix environment with measurable outcomes
• Excellent organizational, change management and time management skills
• Well-developed written and oral communication skills with the ability to explain complex information clearly and convincingly
• Broad knowledge of managed care and state/federal health insurance regulations
• Demonstrated skill and experience in developing highly effective clinical teams
• Strong leadership ability, proven skills in critical thinking and ability to pursue goals with tenacity and sense of urgency
• Demonstrated ability to drive projects resulting in strategic and quality outcomes
• Required Qualifications for specific functional areas:
• Behavioral Health -licensed independent mental health specialist or RN
• Government Programs - current RN licensure or LSWCase/Disease Management
Nice to Have:
• 5 years' experience within insurance or health care setting in case/disease or utilization management
• Bachelor's or Master's degree in health care, business administration, or education preferred
• If a leader of Utilization Management, CCM Certification or ability to obtain within 3 years of starting in the position is preferred.
Role Designation:
Hybrid Remote
Role designation definition: Teleworking is working full time remote. Hybrid is a combination of working onsite and remotely. Onsite is full-time onsite.
Make a difference
Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.
Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.
All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.
Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association Show more details...
Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us...
How Is This Role Important to Our Work?
This role is responsible for leading the day to day operational performance of a care management team while ensuring high quality care management and adherence to regulatory and compliance standards for the Medicaid line of business. The manager is responsible for continued enhancements of operational effectiveness while building relationships with key internal and external stakeholders.
A Day in the Life:
• Manages and leads the overall care management activities and day to day operations of a successful member centric care management team ensuring program activity that achieves strategic goals and objectives.
• Builds a department environment and culture that creates and maintains high performing teams with strong employee engagement.
• Facilitates effective multi -disciplinary teamwork within the department to enhance member care and program performance.
• Design, develop, and implement innovative projects related to care management initiatives that may encompass cross functional and strategic partners.
• Acts as a clinical, care management, and business case consultant for leadership as they relate to case/disease/utilization management.
• Coordinates the development, revision and implementation of care management policies and procedures.
• Assures consistency in processes and function across teams auditing and solid business practices.
• Assure compliance with state and federal regulations, accreditation requirements, contract agreements, and performance guarantees and participates and/or leads with on-site account and provider meetings.
• Excellent communication with members, providers, management, and customers to facilitate success of member and program outcomes, department objectives, and corporate strategic pillars.
• Cultivates strong working relationships across the enterprise to promote successful execution of care management programs and key initiatives.
• Ability to analyze data, conduct root cause analysis, and recommend strategies for pilots, projects, and trends for care management initiatives.
• Manages the department including interviewing and hiring employees following required EEO and Affirmative Action guidelines and ensuring employees receive the proper training.
• Conducts performance evaluation, and is responsible for managing employees, including skill and career development, policy administration, coaching on performance management and behavior, employee relations and cost control.
Required Skills and Experiences:
• Current registered nurse with MN licensure in the state of MN without restrictions or pending restrictions
• 7+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• If a leader of Case Managers, CCM Certification or ability to obtain within 3 years of starting in the position is required.
• 3 years leadership experience leading people, projects, products, or operations
• Strong leadership ability to drive results and excel in a collaborative, matrix environment with measurable outcomes
• Excellent organizational, change management and time management skills
• Well-developed written and oral communication skills with the ability to explain complex information clearly and convincingly
• Broad knowledge of managed care and state/federal health insurance regulations
• Demonstrated skill and experience in developing highly effective clinical teams
• Strong leadership ability, proven skills in critical thinking and ability to pursue goals with tenacity and sense of urgency
• Demonstrated ability to drive projects resulting in strategic and quality outcomes
• Required Qualifications for specific functional areas:
• Behavioral Health -licensed independent mental health specialist or RN
• Government Programs - current RN licensure or LSWCase/Disease Management
Nice to Have:
• 5 years' experience within insurance or health care setting in case/disease or utilization management
• Bachelor's or Master's degree in health care, business administration, or education preferred
• If a leader of Utilization Management, CCM Certification or ability to obtain within 3 years of starting in the position is preferred.
Role Designation:
Hybrid Remote
Role designation definition: Teleworking is working full time remote. Hybrid is a combination of working onsite and remotely. Onsite is full-time onsite.
Make a difference
Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.
Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.
All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.
Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association Show more details...
via Snagajob
posted_at: 1 day agoschedule_type: Full-time
About Blue Cross
Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us...
How Is This Role Important to Our Work?
The Senior Scrum Master will help push for continuous improvement focusing in on four key areas: Organizational Effectiveness (Engaged
About Blue Cross
Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us...
How Is This Role Important to Our Work?
The Senior Scrum Master will help push for continuous improvement focusing in on four key areas: Organizational Effectiveness (Engaged Teams), Customer Value (Building the right things), Quality (Working Product) and Team Effectiveness (Deliver Predictably). This position will work with multiple teams to help teams identify scope to achieve delivery on key outcomes. In the role, the position will help identify and mange impediments, while focusing on Agile best practices. Furthermore, this role will be responsible for helping launch new products or services for their designated product area, assist with large-scale application development, migration to new business applications, outsourcing of business or system capabilities, and infrastructure upgrades. The Senior Scrum Master must ensure that delivery methods occur on an iterative basis leading with agility.
A Day in the Life:
• Uses Agile methodology values, principles, and practices to plan, manage, and deliver solutions.
• Collaborates with product owners on the product development and business requirements.
• Responsible for helping teams build out their backlog and ensure best practices around acceptance criteria.
• Able to conduct journey mapping session, definition of ready and definition of done.
• Incorporates tasks, issues, risks, and action items within Agile process and team backlog.
• Schedules and facilitates scrum events, meetings, and decision-making processes.
• Identifies team opportunities to work with the team and measure data-based improvements.
• Ensure teams follow Agile Life Cycle at a team level or at Scale.
• Ensures the proper use of collaborative processes and removes impediments for the team.
• Ensures initiative processes, deliverables, and financials are tracked.
• Prepares and presents value and Improvement reports to stakeholders.
• Trains, mentors, and supports Agile teams to follow agile values, principles, and practices to develop a continuous improvement mindset.
• Able to tackle special assignments around building Agile competency through data or other small consulting assignments.
• Work with peers to present key impediments impeding progress towards adopting a Product Model.
• Mentor other department team members on core Competenciesto upskill Agile skillset.
• Generally, Sr Scrum Master will have accountability of enterprise product(s). Number of products, product size, revenue impacts and/or complexity are all considerations in performance.
Nice to Have:
• Bachelor's degree in computer science, information technology, business, technical degree or a relevant field
• 5+ years of Agile Team experience or in role experience
• Exposure to Agile backlog management & planning tools from Atlassian (Jira) , Portfolio Management and/or Mural
• Excellent problem solving and analytical skills, including experience leveraging data to inform decision making and independently solving problems
• Leadership and management experience a plus
Required Skills & Qualifications:
• One of the following certifications: Certified scrum master (CSM), Professional Scrum Master (PSM), SAFe or LeSS
• 5+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• Working knowledge of agile methodology, techniques, and frameworks, such as Scrum or Kanban, to deliver solutions
• Utilize data to help tell a story
• Able to build highly engaged teams
• Excellent people and portfolio management skills
• Excellent communication and presentation skills
• Excellent analytical and problem-solving skills
• Adaptability and a willingness to learn new skills
• Expertise in relating strategy to tactics
• Expertise in strategic thinking and strong business acumen
• Adept at working effectively with all functions of an organization in a highly matrixed environment
• Experience creating documentation such as business case documentation or business requirements summaries
• Experience with agile planning tools such as Jira and/or Mural
Role Designation:
Hybrid Remote
Role designation definition: Teleworking is working full time remote. Hybrid is a combination of working onsite and remotely. Onsite is full-time onsite.
Make a difference
Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.
Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.
All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.
Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association Show more details...
Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us...
How Is This Role Important to Our Work?
The Senior Scrum Master will help push for continuous improvement focusing in on four key areas: Organizational Effectiveness (Engaged Teams), Customer Value (Building the right things), Quality (Working Product) and Team Effectiveness (Deliver Predictably). This position will work with multiple teams to help teams identify scope to achieve delivery on key outcomes. In the role, the position will help identify and mange impediments, while focusing on Agile best practices. Furthermore, this role will be responsible for helping launch new products or services for their designated product area, assist with large-scale application development, migration to new business applications, outsourcing of business or system capabilities, and infrastructure upgrades. The Senior Scrum Master must ensure that delivery methods occur on an iterative basis leading with agility.
A Day in the Life:
• Uses Agile methodology values, principles, and practices to plan, manage, and deliver solutions.
• Collaborates with product owners on the product development and business requirements.
• Responsible for helping teams build out their backlog and ensure best practices around acceptance criteria.
• Able to conduct journey mapping session, definition of ready and definition of done.
• Incorporates tasks, issues, risks, and action items within Agile process and team backlog.
• Schedules and facilitates scrum events, meetings, and decision-making processes.
• Identifies team opportunities to work with the team and measure data-based improvements.
• Ensure teams follow Agile Life Cycle at a team level or at Scale.
• Ensures the proper use of collaborative processes and removes impediments for the team.
• Ensures initiative processes, deliverables, and financials are tracked.
• Prepares and presents value and Improvement reports to stakeholders.
• Trains, mentors, and supports Agile teams to follow agile values, principles, and practices to develop a continuous improvement mindset.
• Able to tackle special assignments around building Agile competency through data or other small consulting assignments.
• Work with peers to present key impediments impeding progress towards adopting a Product Model.
• Mentor other department team members on core Competenciesto upskill Agile skillset.
• Generally, Sr Scrum Master will have accountability of enterprise product(s). Number of products, product size, revenue impacts and/or complexity are all considerations in performance.
Nice to Have:
• Bachelor's degree in computer science, information technology, business, technical degree or a relevant field
• 5+ years of Agile Team experience or in role experience
• Exposure to Agile backlog management & planning tools from Atlassian (Jira) , Portfolio Management and/or Mural
• Excellent problem solving and analytical skills, including experience leveraging data to inform decision making and independently solving problems
• Leadership and management experience a plus
Required Skills & Qualifications:
• One of the following certifications: Certified scrum master (CSM), Professional Scrum Master (PSM), SAFe or LeSS
• 5+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• Working knowledge of agile methodology, techniques, and frameworks, such as Scrum or Kanban, to deliver solutions
• Utilize data to help tell a story
• Able to build highly engaged teams
• Excellent people and portfolio management skills
• Excellent communication and presentation skills
• Excellent analytical and problem-solving skills
• Adaptability and a willingness to learn new skills
• Expertise in relating strategy to tactics
• Expertise in strategic thinking and strong business acumen
• Adept at working effectively with all functions of an organization in a highly matrixed environment
• Experience creating documentation such as business case documentation or business requirements summaries
• Experience with agile planning tools such as Jira and/or Mural
Role Designation:
Hybrid Remote
Role designation definition: Teleworking is working full time remote. Hybrid is a combination of working onsite and remotely. Onsite is full-time onsite.
Make a difference
Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.
Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.
All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.
Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association Show more details...
via Snagajob
posted_at: 1 day agoschedule_type: Full-time
About Blue Cross
Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us...
How Is This Role Important to Our Work?
This job implements effective utilization management strategies including: review of appropriateness of pre and post service health
About Blue Cross
Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us...
How Is This Role Important to Our Work?
This job implements effective utilization management strategies including: review of appropriateness of pre and post service health care services, application of criteria to ensure appropriate resource utilization, identification of referrals to a Health Coach/case management, and identification and resolution of quality issues. Monitors and analyzes the delivery of health care services; educates providers and members on a proactive basis; and analyzes qualitative and quantitative data in developing strategies to improve provider performance/satisfaction and member satisfaction. Responds to customer inquiries and offers interventions and/or alternatives. Retrospective clinicians also evaluate appropriateness of code submission on facility and professional claims and complete unspecified code and modifier code reviews.
A Day in the Life:
• Applies clinical experience, health plan benefit structure and claims payment knowledge to pre- service and retrospective reviews by capturing relevant and comprehensive clinical data through multiple sources.
• Leverages clinical knowledge, business rules, regulatory guidelines and policies and procedures to resolve clinical appropriateness.
• Completes review of both medical documentation and claims data to assure appropriate resource utilization, identification of opportunities for Case Management, identify issues which can be used for education of network providers, identification and resolution of quality issues and inappropriate claim submission.
• Maintains outstanding level of service at all points of contact (e.g. members, providers, contract accounts).
• Maintains confidentiality of member and case information by following corporate and divisional privacy policies.
• Accountable for timely and comprehensive review of clinical data with concise documentation, decisions and rationale, according to regulatory standards and procedures.
• Recognizes and raises any trends and emerging issues to management and recommends best practices for workflow improvement.
• Mentors, coaches and fulfills the role of preceptor.
• Demonstrates the ability to handle complex and sensitive issues with skill and expertise.
• Accepts responsibility for and independently completes special projects or reports as assigned.
• Shows strength in all areas of accountability.
• Establishes and maintains excellent communication and positive working relationships with all internal and external partners.
• Identify and refer members whose healthcare outcomes might be improved by Health Coaching/case management interventions.
• Employ collaborative interventions which focus, facilitate, and improve the members health care outcomes. Is familiar with the various care options and provider resources available to the member.
• Educate professional and facility providers and vendors for the purpose of streamlining and improving processes, while developing network rapport and relationships.
• Reviews and identifies issues related to professional and facility provider claims data including resolving appropriateness of code submission, analysis of the claim rejection and the accurate action to complete the retrospective review with the goal of accurate and timely payment to provider and member satisfaction.
• Identifies potential discrepancies in provider billing practices and intervenes for resolution and education with Provider Relations, or if vital involve Special Investigation Unit.
• Monitors and analyzes the delivery of health care services in accordance with claims submitted, and analyzes qualitative and quantitative data in developing strategies to improve provider performance and member satisfaction.
Nice to Have:
• 5 years of RN or relevant clinical experience.
• 1+ years of managed care experience (e.g. case management, utilization management and/or auditing experience).
• Bachelors degree in nursing.
• Certification in utilization management or a related field.
• Experience in UM/CM/QA/Managed Care.
• Knowledge of state and/or federal regulatory policies and/or provider agreements, and a variety of health plan products.
• Coding experience (e.g. ICD-10, HCPCS, and CPT).
Required Skills and Experiences:
• Registered nurse with current MN license or licensed behavioral health clinician without restrictions or pending restrictions.
• All relevant experience including work, education, transferable skills, and military experience will be considered.
• 3 years of related, progressive clinical experience (i.e. RN or LPN to RN mix).
• Demonstrated ability to research, analyze, problem solve and resolve complex issues.
• Demonstrated strong organizational skills with ability to handle priorities and change.
• Proficient in multiple PC based software applications and systems. Demonstrated ability to work independently and in a team environment.
• Adaptable and flexible with the ability to meet deadlines.
• Able to negotiate resolve or redirect, when appropriate, issues pertaining to differences in expectations of coverage, eligibility and appropriateness of treatment conditions.
• Maintains a thorough and comprehensive understanding of state and federal regulations, accreditation standards and member contracts inorder to ensure compliance.
Role Designation:
Teleworker
Role designation definition: Teleworking is working full time remote. Hybrid is a combination of working onsite and remotely. Onsite is full-time onsite.
Make a difference
Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.
Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.
All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.
Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association Show more details...
Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us...
How Is This Role Important to Our Work?
This job implements effective utilization management strategies including: review of appropriateness of pre and post service health care services, application of criteria to ensure appropriate resource utilization, identification of referrals to a Health Coach/case management, and identification and resolution of quality issues. Monitors and analyzes the delivery of health care services; educates providers and members on a proactive basis; and analyzes qualitative and quantitative data in developing strategies to improve provider performance/satisfaction and member satisfaction. Responds to customer inquiries and offers interventions and/or alternatives. Retrospective clinicians also evaluate appropriateness of code submission on facility and professional claims and complete unspecified code and modifier code reviews.
A Day in the Life:
• Applies clinical experience, health plan benefit structure and claims payment knowledge to pre- service and retrospective reviews by capturing relevant and comprehensive clinical data through multiple sources.
• Leverages clinical knowledge, business rules, regulatory guidelines and policies and procedures to resolve clinical appropriateness.
• Completes review of both medical documentation and claims data to assure appropriate resource utilization, identification of opportunities for Case Management, identify issues which can be used for education of network providers, identification and resolution of quality issues and inappropriate claim submission.
• Maintains outstanding level of service at all points of contact (e.g. members, providers, contract accounts).
• Maintains confidentiality of member and case information by following corporate and divisional privacy policies.
• Accountable for timely and comprehensive review of clinical data with concise documentation, decisions and rationale, according to regulatory standards and procedures.
• Recognizes and raises any trends and emerging issues to management and recommends best practices for workflow improvement.
• Mentors, coaches and fulfills the role of preceptor.
• Demonstrates the ability to handle complex and sensitive issues with skill and expertise.
• Accepts responsibility for and independently completes special projects or reports as assigned.
• Shows strength in all areas of accountability.
• Establishes and maintains excellent communication and positive working relationships with all internal and external partners.
• Identify and refer members whose healthcare outcomes might be improved by Health Coaching/case management interventions.
• Employ collaborative interventions which focus, facilitate, and improve the members health care outcomes. Is familiar with the various care options and provider resources available to the member.
• Educate professional and facility providers and vendors for the purpose of streamlining and improving processes, while developing network rapport and relationships.
• Reviews and identifies issues related to professional and facility provider claims data including resolving appropriateness of code submission, analysis of the claim rejection and the accurate action to complete the retrospective review with the goal of accurate and timely payment to provider and member satisfaction.
• Identifies potential discrepancies in provider billing practices and intervenes for resolution and education with Provider Relations, or if vital involve Special Investigation Unit.
• Monitors and analyzes the delivery of health care services in accordance with claims submitted, and analyzes qualitative and quantitative data in developing strategies to improve provider performance and member satisfaction.
Nice to Have:
• 5 years of RN or relevant clinical experience.
• 1+ years of managed care experience (e.g. case management, utilization management and/or auditing experience).
• Bachelors degree in nursing.
• Certification in utilization management or a related field.
• Experience in UM/CM/QA/Managed Care.
• Knowledge of state and/or federal regulatory policies and/or provider agreements, and a variety of health plan products.
• Coding experience (e.g. ICD-10, HCPCS, and CPT).
Required Skills and Experiences:
• Registered nurse with current MN license or licensed behavioral health clinician without restrictions or pending restrictions.
• All relevant experience including work, education, transferable skills, and military experience will be considered.
• 3 years of related, progressive clinical experience (i.e. RN or LPN to RN mix).
• Demonstrated ability to research, analyze, problem solve and resolve complex issues.
• Demonstrated strong organizational skills with ability to handle priorities and change.
• Proficient in multiple PC based software applications and systems. Demonstrated ability to work independently and in a team environment.
• Adaptable and flexible with the ability to meet deadlines.
• Able to negotiate resolve or redirect, when appropriate, issues pertaining to differences in expectations of coverage, eligibility and appropriateness of treatment conditions.
• Maintains a thorough and comprehensive understanding of state and federal regulations, accreditation standards and member contracts inorder to ensure compliance.
Role Designation:
Teleworker
Role designation definition: Teleworking is working full time remote. Hybrid is a combination of working onsite and remotely. Onsite is full-time onsite.
Make a difference
Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.
Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.
All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.
Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association Show more details...
via Diversity Jobs
posted_at: 2 days agoschedule_type: Full-time
About Blue Cross
Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us...
How Is This Role Important to Our Work?
This position is responsible for administering membership and billing in a timely and accurate manner to ensure that members have
About Blue Cross
Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us...
How Is This Role Important to Our Work?
This position is responsible for administering membership and billing in a timely and accurate manner to ensure that members have appropriate access to health care.
A Day in the Life:
• Researches, analyzes, and resolves membership applications and/or reports.
• Provides customer service.
• Initiates, researches, and responds to membership inquiries via telephone and/or written correspondence.
• Analyzes and reconciles various types of accounts receivables related to membership processing that are submitted via check or electronic funds' transfer.
• Verifies, validates, and enters data into various systems (Membership and Billing Systems, etc.) to update and/or generate appropriate member information.
• Works effectively with team members and other areas to resolve inquiries timely and accurately.
• Document any additional information or specific action taken using multiple systems.
• Navigates and analyzes pertinent data from various systems to apply appropriate membership related business guidelines.
• Other duties as assigned.
Nice to Have:
• 1 year of Application Processing, CSR, or Claims experience Microsoft Office Products /Excel-Word Previous cash/financial transaction experience Previous healthcare experience.
• Understanding of background and Medicare regulations and/or CMS compliance and regulations.
• Demonstrated ability to develop and maintain positive working relationships internally as well as externally.
• Flexibility to adapt to changes in procedures.
• Ability to work independently and seek solution to problems.
• Ability to improve or develop new skills in response to change.
Required Skills and Experiences:
• All proven experience including work, education, transferable skills, and military experience will be considered.
• Demonstrated ability to provide good customer service.
• Communication and interpersonal skills to include oral and written communication.
• Attention to detail and high level of accuracy.
• Strong problem solving and decision making skills.
• Ability to follow processes and workflow.
• Adaptable, agile and comfortable with change
• Strong technical competence and navigation skills.
• Keyboarding Accuracy.
Role Designation:
Teleworker
Role designation definition: Teleworking is working full time remote. Hybrid is a combination of working onsite and remotely. Onsite is full-time onsite.
Make a difference
Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.
Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.
All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.
Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association Show more details...
Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us...
How Is This Role Important to Our Work?
This position is responsible for administering membership and billing in a timely and accurate manner to ensure that members have appropriate access to health care.
A Day in the Life:
• Researches, analyzes, and resolves membership applications and/or reports.
• Provides customer service.
• Initiates, researches, and responds to membership inquiries via telephone and/or written correspondence.
• Analyzes and reconciles various types of accounts receivables related to membership processing that are submitted via check or electronic funds' transfer.
• Verifies, validates, and enters data into various systems (Membership and Billing Systems, etc.) to update and/or generate appropriate member information.
• Works effectively with team members and other areas to resolve inquiries timely and accurately.
• Document any additional information or specific action taken using multiple systems.
• Navigates and analyzes pertinent data from various systems to apply appropriate membership related business guidelines.
• Other duties as assigned.
Nice to Have:
• 1 year of Application Processing, CSR, or Claims experience Microsoft Office Products /Excel-Word Previous cash/financial transaction experience Previous healthcare experience.
• Understanding of background and Medicare regulations and/or CMS compliance and regulations.
• Demonstrated ability to develop and maintain positive working relationships internally as well as externally.
• Flexibility to adapt to changes in procedures.
• Ability to work independently and seek solution to problems.
• Ability to improve or develop new skills in response to change.
Required Skills and Experiences:
• All proven experience including work, education, transferable skills, and military experience will be considered.
• Demonstrated ability to provide good customer service.
• Communication and interpersonal skills to include oral and written communication.
• Attention to detail and high level of accuracy.
• Strong problem solving and decision making skills.
• Ability to follow processes and workflow.
• Adaptable, agile and comfortable with change
• Strong technical competence and navigation skills.
• Keyboarding Accuracy.
Role Designation:
Teleworker
Role designation definition: Teleworking is working full time remote. Hybrid is a combination of working onsite and remotely. Onsite is full-time onsite.
Make a difference
Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.
Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.
All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.
Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association Show more details...
via Working At Blue Cross And Blue Shield Of Minnesota
schedule_type: Full-time
About Blue Cross
Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We’re committed to reinventing health care to improve health for our members and the community. We hope you'll join us...
How Is This Role Important to Our Work?
This position in the cost accounting area is responsible for all aspects of administrative expense recording, allocation and reports.
About Blue Cross
Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We’re committed to reinventing health care to improve health for our members and the community. We hope you'll join us...
How Is This Role Important to Our Work?
This position in the cost accounting area is responsible for all aspects of administrative expense recording, allocation and reports. Serves as a resource on generally accepted accounting principals, financial accounting standards board rules. Assists in creating and maintaining internal procedures. Assignments are broad and complex in nature.
A Day in the Life:
• Maintains and analyzes complex administrative expense allocation interrelationships.
• Ensures that systems and procedures are in compliance with company policy and practices. Identifies accounting problems, researches solutions and presents conclusions to management.
• Prepares and/or reviews interpretation of accounting results. Prepares financial reports for internal and regulatory reporting needs. Prepares responses for financial statement and regulatory audits.
• Advises management on meaning of the results.
• Drafts procedures for review.
• Classifies and/or reviews recording of routine to complex accounting transactions.
Nice to Have:
• Bachelor's degree in accounting
Required Skills and Experiences:
• 5+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• Strong solid knowledge and use of Excel
• Financial reporting, audit, journal entry and reconciliations experience
• Strong communication, decision-making and organizational skills
• Ability to maintain positive working relationships
Make A Difference
Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.
Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.
All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.
Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association Show more details...
Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We’re committed to reinventing health care to improve health for our members and the community. We hope you'll join us...
How Is This Role Important to Our Work?
This position in the cost accounting area is responsible for all aspects of administrative expense recording, allocation and reports. Serves as a resource on generally accepted accounting principals, financial accounting standards board rules. Assists in creating and maintaining internal procedures. Assignments are broad and complex in nature.
A Day in the Life:
• Maintains and analyzes complex administrative expense allocation interrelationships.
• Ensures that systems and procedures are in compliance with company policy and practices. Identifies accounting problems, researches solutions and presents conclusions to management.
• Prepares and/or reviews interpretation of accounting results. Prepares financial reports for internal and regulatory reporting needs. Prepares responses for financial statement and regulatory audits.
• Advises management on meaning of the results.
• Drafts procedures for review.
• Classifies and/or reviews recording of routine to complex accounting transactions.
Nice to Have:
• Bachelor's degree in accounting
Required Skills and Experiences:
• 5+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• Strong solid knowledge and use of Excel
• Financial reporting, audit, journal entry and reconciliations experience
• Strong communication, decision-making and organizational skills
• Ability to maintain positive working relationships
Make A Difference
Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.
Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.
All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.
Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association Show more details...
via Salary.com
posted_at: 6 days agoschedule_type: Full-time
About Blue Cross
Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us...
How Is This Role Important to Our Work?
This position is responsible for contributing to and supporting the strategic needs of the company through the application of analytics
About Blue Cross
Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us...
How Is This Role Important to Our Work?
This position is responsible for contributing to and supporting the strategic needs of the company through the application of analytics to diverse business questions and initiatives. The position will work closely with coworkers and internal business partners to clarify requirements, analyze complex data, and produce and present meaningful and defensible results, including the identification of success factors and barriers, improvement opportunities, proposing solutions, and informing strategic decisions. Areas of focus in the department include but are not limited to provider, health management, quality, product development and client/member analytics.
A Day in the Life:
• Uses databases for analysis and dissemination of information.
• Performs complex analysis of data.
• Researches, analyzes data, applies statistical methods when appropriate, and provides interpretation of outcomes.
• Identifies issues to be researched, determining affected areas, estimating the impact and contributing to the resolution.
• Implements improvements to process, analysis, and research methods.
• Works with principal positions and management to understand and interpret the impacts to cost and quality of proposals using relevant data sources and analytic methods.
• Assists in the implementation of new products and systems by providing actionable information and recommendations that evaluate the impact of the proposed products and systems.
• May represent the division on corporate projects and may have leadership roles on these teams.
• Independently manages issues that may arise on multiple tasks or projects with limited management involvement.
• Acts as a resource for other members of the department and company on business issues and may be responsible for training and guidance of other employees.
Required Skills and Experiences:
• 5 years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• 2 years experience using programming and statistical software (e.g., SAS), use of various databases and other data sources, and performing analytics.
• Proficiency in Microsoft software applications such as Word, PowerPoint, Excel, Access.
• Ability to perform and interpret a variety of statistical analyses.
• Demonstrated ability to evaluate and interpret complex data.
• Demonstrated ability to handle multiple tasks with competing priorities.
• Demonstrated problem solving skills.
• Excellent written and verbal communication skills and with an ability to interpret and communicate analytical information to individuals and groups with varying levels of analytics expertise in a clear and concise manner.
• Demonstrated ability to present complex results and conclusions to non-technical audiences and to senior decision-makers.
• Demonstrated ability to work effectively both independently and in a team setting with individuals having diverse professional backgrounds including business, technical, and/or clinical.
Nice to Have:
• Bachelor's degree or Master's degree.
• Knowledge of managed care and health care claims preferred.
• Knowledge of AWS toolset.
• Knowledge of Government programs.
Role Designation:
Teleworker
Role designation definition: Teleworking is working full time remote. Hybrid is a combination of working onsite and remotely. Onsite is full-time onsite.
Make a difference
Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.
Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.
All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.
Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association.
Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, or any other legally protected characteristic Show more details...
Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us...
How Is This Role Important to Our Work?
This position is responsible for contributing to and supporting the strategic needs of the company through the application of analytics to diverse business questions and initiatives. The position will work closely with coworkers and internal business partners to clarify requirements, analyze complex data, and produce and present meaningful and defensible results, including the identification of success factors and barriers, improvement opportunities, proposing solutions, and informing strategic decisions. Areas of focus in the department include but are not limited to provider, health management, quality, product development and client/member analytics.
A Day in the Life:
• Uses databases for analysis and dissemination of information.
• Performs complex analysis of data.
• Researches, analyzes data, applies statistical methods when appropriate, and provides interpretation of outcomes.
• Identifies issues to be researched, determining affected areas, estimating the impact and contributing to the resolution.
• Implements improvements to process, analysis, and research methods.
• Works with principal positions and management to understand and interpret the impacts to cost and quality of proposals using relevant data sources and analytic methods.
• Assists in the implementation of new products and systems by providing actionable information and recommendations that evaluate the impact of the proposed products and systems.
• May represent the division on corporate projects and may have leadership roles on these teams.
• Independently manages issues that may arise on multiple tasks or projects with limited management involvement.
• Acts as a resource for other members of the department and company on business issues and may be responsible for training and guidance of other employees.
Required Skills and Experiences:
• 5 years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• 2 years experience using programming and statistical software (e.g., SAS), use of various databases and other data sources, and performing analytics.
• Proficiency in Microsoft software applications such as Word, PowerPoint, Excel, Access.
• Ability to perform and interpret a variety of statistical analyses.
• Demonstrated ability to evaluate and interpret complex data.
• Demonstrated ability to handle multiple tasks with competing priorities.
• Demonstrated problem solving skills.
• Excellent written and verbal communication skills and with an ability to interpret and communicate analytical information to individuals and groups with varying levels of analytics expertise in a clear and concise manner.
• Demonstrated ability to present complex results and conclusions to non-technical audiences and to senior decision-makers.
• Demonstrated ability to work effectively both independently and in a team setting with individuals having diverse professional backgrounds including business, technical, and/or clinical.
Nice to Have:
• Bachelor's degree or Master's degree.
• Knowledge of managed care and health care claims preferred.
• Knowledge of AWS toolset.
• Knowledge of Government programs.
Role Designation:
Teleworker
Role designation definition: Teleworking is working full time remote. Hybrid is a combination of working onsite and remotely. Onsite is full-time onsite.
Make a difference
Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.
Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.
All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.
Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association.
Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, or any other legally protected characteristic Show more details...
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