Resp & Qualifications
PRINCIPAL ACCOUNTABILITIES: Under the direction of the Supervisor or Manager, the principle duties and responsibilities include, but are not limited to, the following:
• Actively participate in planning sessions to ensure that the team’s tactical and strategic operational goals are aligned with other CareFirst department’s staff, IT, and clients.
• Provide input to the development of project plans for day-to-day changes, corporate initiatives, and other projects.
• Provide feedback for development of resource estimates, timeframes, and provide input to cost/benefit analysis that will be used to develop ROI business cases and budgets for initiative projects.
• Support and/or perform corporate processes for systems and process change management, spanning request submission, review, validation, prioritization, scheduling, and status reporting.
• Provide support for project configuration, testing and implementation where required.
• Review corporate communications, promotional literature, internal documents, ecommerce documents and training materials to ensure contract integrity.
Annual Contract Build/Regulatory Support
• Ensure successful completion of day-to-day changes, corporate initiatives, and other projects by completing the activities necessary to satisfy the requirements of the implementation memos. This includes, but is not limited to terminating existing forms, cleaning, importing and testing new forms.
• Creating new logics (rules) and updating the changes in existing logics. Revising the Database Tables to reflect current requirements, building new product templates and updating code strings/product IDs and creating the required sample contracts that support the implementation memo.
• Updating and providing the applicable logs and charts relevant to Work Requests.
• Meeting critical deadlines and/or timely delivering/providing the appropriate level of analysis that support the requirements or specifications and implementation impact assessment that is due.
• Also provides support for the successful completion of other related tasks, such as the daily maintenance of issue logs, system control files, benefit files, and tracking/updating user documentation.
• Utilizes team controls and processes for production systems support and monitoring, which includes issue analysis, tracking, and resolution.
• Serves as a subject matter expert in areas of system/business expertise.
Contract Production Support
• Reviews, edits, and performs analysis of business systems, processes, and documentation making necessary corrections to improve the performance and accuracy of existing configuration builds, processes, and documentation.
• Research and resolve issues that have been reported to team through emails and other means in a timely manner. This includes updating BSBS/Product ID Code String request that are part of standard and non-standard 200+ requests, MIA/Nurse Appeals, and locking or unlocking groups from the system library Nonstandard list from the Database Tables.
• Addressing Contract inquiries from other areas that are appropriate that include Fully Insured Groups, validating documents being used in current contracts are relevant for the contract year implemented.
System and Process Improvements
• Proactively participate/lead in the technical research and business process improvements that help identify opportunities for improved systems and/or business processes.
Required: This position requires a bachelor’s degree or equivalent work experience. The candidate should have a minimum of 3 years of experience in managed healthcare claims or member services utilizing systems that support the administration of the related functions, with at least 2 years of experience providing analytical support of business processes and/or systems to increase/enhance operational effectiveness.
Demonstrated systems experience to include working on contract generating platforms along with basic understanding of business rules along with contract language and product knowledge. Thorough understanding of BCBS contract language systems and reports is necessary. Detailed knowledge of benefits packages, membership and claims systems. Knowledge of administrative and internal procedures is essential, including internal/external operating policies, business rules by product and platform, medical policy and BCBSA standards, MIA/VBOI regulations and governance, SAS70 and Sarbanes Oxley compliance.
Abilities/Skills: Relevant business and systems subject matter expertise. Must have the ability to work independently and as part of a team. The incumbent will have excellent interpersonal skills with the ability to lead problem-solving discussions. Attention to detail and excellent analytical and problem-solving skills. The incumbent should also have a working knowledge of Project management and working knowledge of the Software Development Life Cycle skill sets. Excellent written and verbal communication skills, excellent organizational skills and ability to set priorities and handle multiple projects concurrently are also required. Extensive PC skills including Microsoft office software such as Word, Excel, and PowerPoint are required for daily work tasks.
The incumbent 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.
Preferred: SOP writing experience. Experience in creating and documenting business processes and workflow along with experience with both mainframe and client/server technology is preferred. Training experience is also encouraged.
Department: Benefit Contract Management
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: 10/6/2018
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, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship