Jobs at Health Care Service Corporation

Lead state-level government and regulatory relations for BCBSMT and HCSC West Region, guide legislative and health policy strategy, oversee external lobbyists and regulatory engagement, coordinate with Legal and Compliance, manage stakeholder relations and events, and oversee budgeting, business cases, and ROI analyses.

Develop, maintain, and enhance reporting and analytical solutions; partner with stakeholders to deliver insights on utilization, financial performance, enrollment, and other healthcare metrics; build recurring reports and ad hoc analyses; create dashboards and translate complex healthcare and financial data into actionable recommendations for clients and business partners.

Lead IFM analytics and reporting to drive financial, sales, and operational performance. Deliver monthly financial reporting, claims and call center analytics, forecasting, dashboarding, and vendor invoice validation. Partner with Finance, Sales, Operations, Actuarial, and IFM leadership. Manage and develop a team of analysts, prioritize work, and translate complex data into actionable recommendations to optimize business performance.

Use actuarial, statistical, and financial methods to price, reserve, forecast, and analyze insurance products. Communicate results to varied audiences, manage small projects, and support underwriting, reserving, and financial reporting.

Manage development, implementation, maintenance, and review of actuarial models and systems for pricing, underwriting, reserving, forecasting, and statistics. Build complex models, mentor others, produce presentations for decision-making, and lead cross-functional projects. Must have deep expertise in at least one actuarial area or business segment.

Manage and recruit external producers (brokers/agents) to sell individual and ancillary health insurance products. Drive new sales growth, provide training, review producer performance, build relationships, and ensure timely service to producers.

Participate in implementation, maintenance, and detailed analysis of actuarial models and systems for pricing, underwriting, reserving, forecasting, and statistics. Develop and run complex models, analyze results, and produce basic written and oral presentations to support decision making.

The role involves delivering sales results in health insurance across the Southern Illinois and St. Louis area, focusing on broker relationships, education, and achieving sales goals.

Provide budgeting and financial analysis support for internal operations, develop and maintain complex financial models, analyze trends and performance metrics, present findings to management, identify risks and process improvements, and consult with business partners on budget-to-forecast and cost analysis.

Sell and renew products and services to existing customers, negotiate renewals, understand customer needs, provide support, analyze reports, build strong customer relationships, and travel as required (including overnight).

Manage a sales team focused on new group health care and ancillary sales via brokers. Set and drive sales goals, educate and build broker relationships, collaborate across the company, analyze and present sales reports, and travel as needed.

Sell group health insurance products (directly or via brokers) to meet sales targets. Develop and maintain client and broker relationships, present products, negotiate and close larger group accounts, and travel regionally as needed.

Provide field service and education to federal employees and agencies within an assigned territory, promote enrollment growth for medical, dental, and vision plans, conduct presentations and enrollment events, resolve claims/enrollment issues, maintain relationships with Health Benefits Officers, track activities and reports, and meet sales/service targets.

Manage real-time/intraday workforce for front- and back-office functions: monitor SLAs, productivity, staffing and inventory levels; analyze data and queues to improve caller experience; use WFM tools to recommend schedule and process improvements; prepare reporting for leadership.

Adjudicate and process medical, dental, vision, life and disability claims per plan documents and regulations. Investigate claims, calculate benefits, communicate decisions, advise team members, handle inquiries/correspondence, and use MS Office tools while meeting turnaround times and quality standards.

Lead technical analytics for client and employer reporting: gather requirements, build/validate/automate reports and data files, perform UAT and dataset comparisons using SQL/Python/R, design monitoring and validation automations, and enable stakeholder self-service while applying healthcare claims and enrollment domain knowledge.

Serve as a strategic HR leader aligned to business groups, partnering with senior leaders to design and implement talent, culture, org design, workforce planning, change management, and leadership development solutions that enable business performance and connect HR Centers of Excellence to the business.

Provide strategic legal support related to HCSC's provider network and internal business teams, addressing regulatory and operational matters while managing legal risks and litigation.

Manage existing health insurance products and develop strategy for current and next-generation solutions. Drive product lifecycle from ideation to launch, analyze market trends, create marketing strategy and collateral, monitor performance and pricing, support sales/account teams, deliver training and client reporting, and act as product subject matter expert.

Adjudicate and process medical, dental, vision, life and disability claims per plan documents and regulations. Secure and analyze claim information, calculate benefits, communicate decisions, meet turnaround times, provide customer service, and use proprietary systems and MS Office tools under general supervision.