The posting
Summary
Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!
Description
Position Purpose: Analyzes current and proposed policies, procedures, systems, forms, and reports for the department. Analyzes existing processes and procedures to recommend operational improvement through standardization, simplification, discontinuance or other methods. May recommend installations of new systems and procedures and with implementation, instructs personnel regarding them. Interprets complex CMS Change Requests (CRs), implements CMS regulatory updates, analyzes operational inquiries, and monitors benefit grid accuracy and compliance.
Location: This position is full-time (40 hours/week, 8 hours/day) Monday – Friday and is located at 17 Technology Circle in Columbia, SC and a Hybrid flexible work arrangement is in place.
Sponsorship: This position is not eligible for sponsorship now or in the future.
What You’ll Do:
- Analyze data that has a vital impact on the success of the operation, program or project and that is used for developing operating strategies. Develop, maintain and review processes, procedures, policies and forms for the department. Identify patterns and trends in data for business decisions by department or division leadership. Prepare materials which help explain findings such as reports, charts, visual aids, etc. Monitor departmental methods to ensure compliance with internal measures and contract/business requirements.
- Review items directed to management. Advise and keep management apprised of any potential issues or items that need to be addressed. Recommend a response or solution to any issues identified or outstanding. Assist management with complex reviews such as analysis of expenditures that would help determine if process improvements, projects, or implementations are within projections. Provide periodic/consistent information to management impacted by assigned projects. Manage/relay project status, purpose, scope and timing.
- Serve as liaison between the division or department and other areas on management reports, including reports concerning workload statistics. Attend and participate in teleconferences and meetings with customers. May also serve as liaison between the area and the contractor regarding any discrepancies found in reports.
- Functions as a project leader on work teams. Assist service areas with resolving compliance issues or questions. Identify opportunities for improvement and areas/issues that can be addressed with educational initiatives. Train staff on new initiatives.
- Identify and research discrepancies and questions related to data input based on reports. Monitor reports to assess the impact of performance on key measures.
To Qualify For This Position, You'll Need The Following:
Required Education:
- A Bachelor's degree OR 4 years of job-related work experience OR
- An Associate’s degree AND 2 years of job-related work experience.
Required Work Experience:
- 4 years of data analysis or related operations experience.
Required Skills and Abilities:
- Strong communication, analytical, project management and organizational skills.
- The ability to fully understand acceptable internal standards and methodologies.
- Advanced analysis skills.
- The ability to identify complex problems and recommend solutions.
- The ability to provide guidance and lead in developing and implementing process improvement for the department and division.
- Knowledge of Microsoft Office applications.
We Prefer That You Have The Following:
Preferred Work Experience:
- 5 years claims processing experience
- Exposure to CMS, Medicare Advantage, or government programs
Preferred Software and Tools:
- DB2
Our Comprehensive Benefits Package Includes The Following:
We offer our employees great benefits and rewards. You will be eligible to participate in our benefits program the first of the month following 28 days of employment.
- Subsidized health plans, dental and vision coverage
- 401k retirement savings plan with company match
- Life Insurance
- Paid Time Off (PTO)
- On-site cafeterias and fitness centers in major locations
- Education Assistance
- Service Recognition
- National discounts to movies, theaters, zoos, theme parks and more
What We Can Do for You:
We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.
What To Expect Next:
After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.
Equal Employment Opportunity Statement
BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.
We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.
If you need special assistance or an accommodation while seeking employment, please email [email protected] or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information.
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