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Blue Cross & Blue Shield jobs in Nashville, TN - 3 jobs

  • Manager, Medicare Claims

    Blue Cross and Blue Shield of North Carolina 4.3company rating

    Blue Cross and Blue Shield of North Carolina job in Nashville, TN

    The Manager, Medicare Claims, oversees end-to-end claims services for provider segments, meeting business goals. This role sets performance targets, manages claims processing and financials, handles submissions, refunds, and recoveries, and ensures claims accounting and reporting. Collaboration with claims leadership ensures alignment with customer needs and contracts. What You'll Do Streamline shared processing to reduce management by exception Set operational process to address market trends, BCBSNC capabilities and customer demand Manage accounting and financial reporting functions in support of the Finance Division including overseeing the gathering, preparation, analysis, and reconciliation of financial data to ensure compliance with accepted accounting principles and standards. Participate in projects to improve and/or facilitate claims processing, recovery, and accounting functions. Manage financial recovery activities including refunds and collections Manage team leads and staff by efficiently driving work volume to keep high level of utilization and engagement in the group Resolve complex claims appeal by coordinating with different stakeholders for certain high value claims Collaborate with Audit and Payment Integrity to sustain a pre-determined level of accuracy and quality Design and develop tools and techniques for improvements. Identifies needed process and procedural changes which will result in improved customer satisfaction. Serve as Medicare Claims Subject Matter Expert and single point of contact for performance monitoring and troubleshooting. Represent Claims Operations on monthly CMS calls with CMS Account manager answering questions, providing status updates and expertise routinely and on demand. Ability to engage as requested by Compliance with regulatory entities, especially CMS on monthly calls and serve as an internal point of contact to prepare feedback on issues under CMS review. Use good judgement in understanding issues and work with compliance to prepare for discussions. Ability to represent claims as a knowledgeable SME. What You Bring Bachelor's degree or advanced degree (where required) 8+ years of experience in related field. In lieu of degree, 10+ years of experience in related field. Bonus Points 1-2 years of Medicare and Medicaid experience or a highly regulated operational environment - highly preferred Strong analytical skills with the ability to drive change and manage operations Ensure risks associated with business activities are effectively identified, measured, monitored and controlled within accordance with compliance policies and procedures What You'll Get The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community. Work-life balance, flexibility, and the autonomy to do great work. Medical, dental, and vision coverage along with numerous health and wellness programs. Parental leave and support plus adoption and surrogacy assistance. Career development programs and tuition reimbursement for continued education. 401k match including an annual company contribution Salary Range At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs.Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. *Based on annual corporate goal achievement and individual performance. $98,092.00 - $156,947.00 Skills Accounts Receivable (AR), Claims Analysis, Claims Management, Claims Processing, Claims Resolution, Claims Submission, Documentations, Financial Processing, Health Insurance, Insurance Claim Handling, Insurance Claims Processing, Insurance Industry, Medicare Advantage, People Management, Recruiting
    $98.1k-156.9k yearly 4d ago
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  • Manager, IT Category Management

    Blue Cross and Blue Shield of North Carolina 4.3company rating

    Blue Cross and Blue Shield of North Carolina job in Nashville, TN

    The Manager, IT Category Management, is responsible for directing all sourcing and vendor contracting activities within the assigned categories. This role supervises staff engaged in the sourcing process for high-value and complex goods, services, or projects and initiatives. The incumbent focuses on reducing organizational costs by implementing effective sourcing strategies, tools, and processes. Coordination with third-party vendors, business owners, and the legal team is essential for the preparation, analysis, and negotiation of vendor contracts. Additionally, this position supports business owners across all functional areas in technology vendor selection and ensures that vendor obligations are documented in alignment with business requirements. What You'll Do Manage staff responsible for the development and execution of sourcing strategies in one or more technology categories. Direct and train staff in conducting sourcing events, including development of project work plan, category profile, category strategy, minimum requirements and evaluation criteria, solicitation Guide staff in the development and implementation assorted bid documents and requests (i.e. RFP, RFI, RFQ); and manage status reporting and performance metrics of sourcing and category management activities. Understand, analyze and forecast complex market and industry dynamics and share subject matter expertise and industry knowledge within the established portfolio of products and services Partner with stakeholders to develop business and sourcing strategy and source products and services using proven tools, processes, and analytics to drive and achieve business results. Coordinate the evaluation and analyses of sourcing results from a total cost of ownership perspective, and provide optimization recommendations Lead cross-functional teams responsible for complex vendor negotiations, including those that require specialized subject matter expertise, nonstandard risk mitigation solutions, and coordination of multiple arrangements. Proactively establish and foster successful, positive working relationships with vendor personnel. Drive vendor engagement through formal and informal transactions. Manage contract management function and facilitate effective collaboration with Corporate Compliance, Legal, Audit and Risk Management and other internal stakeholders for compliance activities to ensure regulatory conditions are met. Develop new procedures, training, initiatives, specifications and recommendations for process or policy changes and improvements, as appropriate. What You Bring Bachelor's degree or advanced degree (where required) 8+ years of experience in related field. In lieu of degree, 10+ years of experience in related field. Bonus Points 8+ years Technology procurement experience Highly Preferred Procurement experience at a healthcare company Highly Preferred Procurement experience with key vendors including IBM, Microsoft, Salesforce, ServiceNow, Cognizant, Accenture, NTT Data and HCL Technologies Experience purchasing hardware and software through Value Added Resellers What You'll Get The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community. Work-life balance, flexibility, and the autonomy to do great work. Medical, dental, and vision coverage along with numerous health and wellness programs. Parental leave and support plus adoption and surrogacy assistance. Career development programs and tuition reimbursement for continued education. 401k match including an annual company contribution Salary Range At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs.Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. *Based on annual corporate goal achievement and individual performance. $107,901.00 - $172,642.00 Skills IT Procurement, Negotiation, Strategic Sourcing, Vendor Procurement
    $107.9k-172.6k yearly 3d ago
  • Business Applications Analyst (Actuarial & Data Focus)

    Blue Cross and Blue Shield of North Carolina 4.3company rating

    Blue Cross and Blue Shield of North Carolina job in Nashville, TN

    Join a team where technology meets strategy. As a Business Applications Analyst, you will play a crucial role in assisting with delivering technical data support and innovative solutions for Actuarial financial data systems and Marts. You'll Identify simple to moderate business requirements and solutions related to the support of the specific business area/function. Additionally, you will assist in preparing trend and financial data analyses to support various Plan divisions. What You'll Do Assist in developing decision support solutions; including Medical/Pharmacy claim financial data builds, data extracts, reports, data mart tables, views and/or analysis. Provide support for multiple data application areas, including data definitions, usage and file structure, technical structure of the SQL code, business rules, and requirements that governs the functionality of the data systems. Assist in the development, design and testing of data sets delivered thru the Actuarial data marts. Assist with monthly data refreshes, validations, and quality assurance checks to support financial reporting. Identify best practices, communicate and implement these practices within the department. Support in analyzing data, system problems and incidents; develop recommendations and solutions for those problems, implement those solutions, and provide communications on the associated actions, business impacts, and results. Provide data support to senior team members on at least one business project team and non-project related activities. Perform unit testing; creating sample data sets to validate that SQL code/logic is developed to perform as intended. Provide analytical and ad hoc support for departmental, divisional and corporate projects as needed to accomplish business goals and to ensure the business needs are met. Documentation - writing system/technical specifications to ensure solution supports functional requirements. What You Bring Bachelor's degree or advanced degree (where required) 3+ years of experience in related field. In lieu of degree, 5+ years of experience in related field. Bonus Points 3+ Years of SQL Analysis/ Development experience - Highly Preferred Experience with Medical claims, Pharmacy and/or medical rebate data. Healthcare data analytics experience, including experience with Government and Commercial lines of business. Experience with Snowflake, AWS cloud environments. What You'll Get The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community. Work-life balance, flexibility, and the autonomy to do great work. Medical, dental, and vision coverage along with numerous health and wellness programs. Parental leave and support plus adoption and surrogacy assistance. Career development programs and tuition reimbursement for continued education. 401k match including an annual company contribution Salary Range At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs.Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. *Based on annual corporate goal achievement and individual performance. $73,698.00 - $117,917.00 Skills Business Requirements Analysis, Critical Thinking, Database Management Systems (DBMS), Data Cleansing, Data Mart, Data Validation, Data Wrangling, Problem Solving, Requirements Analysis, Requirements Gathering, Structured Query Language (SQL), Structured Query Language (SQL) Development, System Testing, Technical Requirements, Unit Testing
    $73.7k-117.9k yearly 3d ago

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