Resp & Qualifications
PURPOSE: Lead, direct and oversee the information management for all units within the Special Investigations department. Responsible for data extraction and analysis units. Works extensively with each of these units in defining report requirements and designing reports of extracted data. Assists units in analyzing extracted data. Responsible for responding to data analysis requests from corporate business units related to Subpoena requests, Association data requests and External Legal requests. This position is responsible for being the liaison between TOSS and Special Investigations business. Will be participating in the SI Corporate Initiative to build new technology and the ongoing day to day management of the technology moving forward.
PRINCIPAL ACCOUNTABILITIES: Under the general guidance of the VP, SI, the duties include but are not limited to:
Plans and directs the data extraction requests for Special Investigations and Payment Integrity. Identifies requirements (e.g., data, information needs, processing, specific output, functional and development of test data), and determines their desired outcomes in order to formulate the design program and/or offer alternative solutions in a timely manner and with associated estimates of effort level. Directs system analysis and designs technical specifications for complex modules, including coding, testing and debugging documentation of programs. Works closely with managers of Special Investigation and Payment Integrity to maximize our opportunities for recovery. Participates in any Corporate Initiative that may be identified. Prioritize multiple tasks to meet established deadlines and satisfy internal and external customer demands.
Works with Special Investigation and Payment Integrity to design and implement efficient technical solutions to address business needs, including automation of manual processes, implement solutions to mandated requirements, solutions to new business requirements and responding to vendor software changes.
Plans and oversees the technical implementation of software used in Special Investigation and Payment Integrity. Plans and schedules the software upgrades for minimal impacts. Directs the validation of data to ensure the accuracy of data. Acts as liaison between Special Investigations, Payment Integrity and Data and Informatics. Proactively directs the analysis and review of emerging technology to determine best solutions in line with Special Investigation strategies, goals and objectives.
Supports Special Investigation and Payment Integrity software by developing, coordinating, scheduling and executing technical training of any new software or Corporate Initiative.
This position has supervision over 2 programmers.
Minimum Qualifications and Skills: This position requires a BS/BA degree in Business Administration, Management Science, IT Systems, Finance and/or Accounting and five years of progressively responsible management experience. Incumbent must demonstrate leadership qualities, along with thorough functional expertise, technical expertise, business perspective; and must possess excellent oral and written communication and presentation skills. Incumbent must have excellent analytical and problem- solving skills, excellent project management skills, strong interpersonal skills and strong IT skills including Access, Lotus Notes and Excel. Thorough knowledge of system architecture, enterprise solutions, database construction, utilities and data structures. Functional/technical knowledge of corporate systems (CARE, FLEXX, NASCO, FACETS, etc.)
Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Department: Special Investigations Unit - Technology & Analysis
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Please apply before: 5/26/2018
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type or key and handle or feel small controls and objects.
The physical demands described are representative of those needed by an associate to perform the essential duties and responsibilities of the position successfully. Requirements may be modified to accommodate individuals with disabilities.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship