A career with the Blue Cross Blue Shield Association allows you to be part of the organization that supports Blue Cross and Blue Shield companies nationwide. We seek to improve health care quality, affordability, and accessibility for all Americans, and we want you to join the team!
Driven by our North Star, to expand access to high-quality, affordable care for every community we serve, we foster a culture grounded in collaboration, accountability, and continuous improvement. Our people experience is built on meaningful work, competitive total rewards, and opportunities for growth, empowering you to make an impact while thriving both professionally and personally.
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This role is responsible for the business analytical audits relating to the distribution of the BCBSA incentive programs, leads the development and design of business solutions, and applications that directly support the framework activities related to the BCBSA Audit Program that measures the performance of financial and operations controls. Identifies and drives process and system enhancements to improve efficiencies within the BCBSA Audit Program. Performs systematic data analysis including financial, medical claims, pharmacy claims, and member enrollment/eligibility data ensuring the interpretation of audit findings and development of recommendations and/or strategies to meet BCBSA core quality objectives. Develops and performs complex root-cause analyses, and data analyses to improve quality and efficiency of the core BCBSA Audit Program.- Provide leadership and management of the audit activities associated with the BCBSA Incentive program, develops, executes and maintains the automation infrastructure used to ensure the timely and accurate distribution of award payment according to projected schedules.
- Leads projects to ensure the successful implementation of prepayment controls into the BCBS Claims System to ensure accurate claims' adjudication consistent with government contracts.
- Provides ongoing technical support to Audit teams and BCBS Plans throughout the life-cycle of all BCBSA or Affiliated companies' audits
Contribute and participates on initiatives and projects involving healthcare data and information solutions - Serves as liaison and SME working directly with BCBSA or Affiliated companies to ensure business requirements and functional requirements are developed for the successful implementation of system enhancements to resolve audit findings
The posting range for this position is:
97,900.00 - 141,925.00Qualifications:
Education
- Required Bachelor's Degree Business administration with a concentration in management information systems or health care, or equivalent work experience
- Preferred Master's Degree
Experience
- Required 5+ Years specific formal software/system testing experience within a business environment; within a managed care or health services delivery setting
Knowledge Skills and Abilities
- Proficient use of Microsoft 365, Excel, Visual Basic, and SQL programming language
- Analytic skills in predictive modeling and risk stratification, including a working knowledge of quantitative analysis, prevalence, ROI, outcome measurements, benchmarks, trends and outliers
- Data modeling skills with Microsoft Access and development skills using VBA, SQL, forms and reports.
- Verbal and writing skills
- Intermediate knowledge of auditing, finance and claims operations.
- Advanced analytic skills in predictive modeling and risk stratification, including a working knowledge of quantitative analysis, prevalence, ROI, outcome measurements, benchmarks, trends and outliers
- Expert use of Microsoft 365, Excel, Visual Basic, Tableau, IDEA/Advantage Sweet and SQL programming language
- Ability to create strategies that support initiatives and translate these into action plans
- Ability to build consensus for business results in a decentralized decision-making structure
- Excellent interpersonal and communication skills
- Ability to translate and present complex business concepts and/or quantitative information in a clear, concise and understandable manner
- Ability to plan, facilitate and present at meetings and conferences.
- Ability to interact effectively with senior management both internal and external to the Association
- Preferred: Demonstrates AI literacy and an understanding of generative AI tools, including appropriate business applications and limitations.
Extra Posting Information:
Five or more years of specific formal software/system testing experience within a business environment; within a managed care or health services delivery setting
Experience in software development and information systems integration; documenting System Requirements, Operational Requirements, Test and Evaluation and User and Administrator Training.
Experience in health care or government-contracting environment/ Blues Plan experience
#LI-Hybrid
The posted salary range is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the hiring range and this hiring range may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs. This job is also eligible for annual bonus incentive pay.
We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.
Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
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NOTICE OF USE OF ARTIFICIAL INTELLIGENCE
Blue Cross and Blue Shield Association (“BCBSA”) is committed to ensuring compliance with federal, state, and local laws governing the use of technology in the employment context. BCBSA uses artificial intelligence (“AI”) tools to assist with our recruitment process. All hiring decisions remain subject to human review and oversight.
Skills Required
- Bachelor's degree in business administration with a management information systems or healthcare concentration, or equivalent work experience
- 5 or more years of formal software or system testing experience in a business environment, preferably managed care or health services delivery
- Proficiency with Microsoft 365, Excel, Visual Basic, and SQL
- Advanced analytical skills in predictive modeling and risk stratification
- Data modeling and development experience using Microsoft Access, VBA, SQL, forms, and reports
- Knowledge of auditing, finance, and claims operations
- Experience with software development and information systems integration
- Experience documenting system requirements, operational requirements, testing and evaluation, and user and administrator training
- Experience in healthcare, government contracting, or Blue Cross Blue Shield plan environments
- Expertise with Tableau and IDEA/Advantage Sweet
- Master's degree
- AI literacy and understanding of generative AI tools, applications, and limitations
What We Do
Blue Cross Blue Shield Association is a national federation of 34 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide health care coverage for one in three Americans. BCBSA provides health care insights through The Health of America Report series and the national BCBS Health Index.
