Resp & Qualifications
PURPOSE: The incumbent is responsible for providing analytical support for existing systems as well as participating in the design and implementation of new systems to ensure claims and service applications are operating effectively and efficiently to achieve ASU goals and objectives. The incumbent will participate in the analysis of existing business processes and systems to recommend process and system enhancements. The incumbent may coordinate with or provide consulting services to other CareFirst departments and external entities, such as vendors, consultants, auditors, other BCBS Plans, BCBSA, the FEP Director’s Office, and government agencies such as the Office of Personnel Management. The incumbent is a subject matter expert in support of claims processors, adjustors, customer service representatives, OPL analysts, etc. and provides support to those individuals in conjunction with department supervisors to ensure continuous improvement to job knowledge, quality, and productivity to better serve CareFirst customers
Under the general supervision of a Manager or above the incumbent’s accountabilities may include, but are not limited to, the following:
Required: This position requires a bachelor’s degree or equivalent work experience. Must have been a Claims Processor II or above (substitute CSR II or above, Full Service CSR II or above, Adjustor II or above, Quality Assurance Analyst II, E&B Tech II or Sr. OPL Analyst above) for a minimum of 4 years, or 2 years Claims Liaison experience.
Demonstrated systems experience to include: FACETS and/or FLEXX and/or NASCO/and or CARE experience. Thorough understanding of BCBS claims and service 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. Ability to work independently and as part of a team. Excellent interpersonal skills. Ability to lead problem-solving discussions. Attention to detail and excellent analytical and problem-solving skills. Excellent written and verbal communication skills. Excellent organizational skills and ability to set priorities and handle multiple projects concurrently. Extensive PC skills including Microsoft office software such as Word and Excel.
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 with both mainframe and client/server technology. Training experience.
IT & Busi Support Contact Center
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: 12/06/2019
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