Customer Service Representative | Medicare Markets Division

Blue Cross Blue Shield of Massachusetts
Remote or Hingham, MA
Ready to help us transform healthcare? Bring your true colors to blue.

Customer Service Representative | Medicare Markets Division

$1,000 Sign-on Bonus! *

Remote Work AvailableFull Time$20.00/ hr ($39,000/year)

As a Member Service representative for Medicare Markets, your role is one of the most important positions at Blue Cross Blue Shield of Massachusetts. You are the voice of Blue Cross when our members have questions, need help understanding their benefits, and so much more. Our ability to provide outstanding service to our members continues to be a top goal for every associate.To prepare you to join our team, you will complete a comprehensive training program that includes in-person or virtual classroom learning. Included in your learning, you will participate in role playing scenarios, call listening sessions, and partner work. In addition, you will receive hands on classroom style learning and mentoring with current associates where you will listen to live member calls.

Your 8-10 week training program takes place Monday through Friday from 8:00 AM - 4:00 PM at our Hingham office or online in our virtual classroom. After training, your schedule will shift to a flex schedule. Your flex schedule is a combination of a work shift arrangement that can start as early as 8:00am and end as late as 6:00pm.

At Blue Cross Blue Shield of Massachusetts, we value our employees as much as our members. This job isn't for the faint of heart. No two members, problems, or resolution journeys are the same. Sometimes you won't know the right answer, but we're looking for someone who is always up for the challenge.

Our associates are the kind of people who care. Our members have Medicare either because they are 65 or older or are eligible for Medicare because of disability. Our associates strive to offer support whether its helping members navigate through benefits, online resources or just providing peace of mind.

We're looking for people best described as...

+ A proactive, solution-oriented decision maker

+ A planner, multi-tasker, and expert problem solver

+ Empathetic, caring, and willing to go the distance to help someone

+ Honest, with a "can-do" attitude and infectious positivity

What You'll Do In Your Role

As a Medicare Markets Member Service Representative at Blue Cross Blue Shield of Massachusetts you are in charge of solving members' problems and helping them get back to enjoying their lives as quickly and effortlessly as possible. You are empowered to provide members with peace of mind that their questions and concerns are resolved and none are on the horizon.

Successful associates deliver an effortless member experience by:

+ Taking the lead - our associates take ownership of members' issues, relieving members' stress while guiding them to a quick and easy resolution.

+ Identifying future problems - not only do our associates solve the current member concern but they actively identify and solve any complications the member may encounter after their first interaction.

+ Sharing insights with peers and management - our positive team culture relies on open communication to continuously improve how our work gets done.

+ Show compassion - our associates show empathy and compassion during a time of need, whether that is due to a loved ones passing or acknowledging a difficult situation and finding the right resources to help

+ Having fun ! - our work is important, but we don't take ourselves too seriously. We love helping others and have a fun community dedicated to doing so!

Our Investment In You

Don't worry - you don't have to be an expert to become one! So long as you bring your passion for people and problem solving, we'll invest in you to take care of the rest. We'll provide fun, thorough, and paid training that will teach you everything you need to know to feel confident handling member issues with a team of support by your side.

As a Medicare Markets associate, you are the face of our company, and at Blue Cross Blue Shield of Massachusetts we believe it's important to ask for your input on anything from member solutions to workspace design.

Join our team to enjoy:

+ * $1,000 Sign-On Bonus! (The sign on bonus will be paid out in 4 installments of $250, after 3, 6, 9, and 12 months of employment. Associates must remain employed with the company in order to receive each of the installment payments.)

+ PAID TRAINING!

+ Earn a salary increase! You will be eligible upon successful completion of additional product training, provided you are in good standing at the time.

+ Recognition and rewards for high-performance and improvement

+ Internal career pathing with individual mentorship, networking, and events

+ Employee resource groups for employees with shared backgrounds or the desire to learn more about their colleagues. All are welcome at our ERGs!

+ A dynamic work environment that keeps you thinking!

+ Best in class health, wellness, and retirement benefits among many others!

+ Performance based annual bonuses

Education and Experience:

+ High school diploma or equivalent required

+ BS/BA degree preferred or equivalent work experience

+ 2-3 years customer service experience

If interested, you can expect an email within one day of application to begin the hiring process by taking an online assessment in the comfort of your home. If you think you have what it takes, take the plunge and apply today!

***This position has been identified as essential to the operations of the company in the event of a building closure due to weather, emergency, or disaster. Holding an essential position, you may be expected to bring a company issued laptop home and work from home or other remote location in the event of a building closure, emergency, or disaster.

Minimum Education Requirements:

High school degree or equivalent required

LocationHinghamTime TypeFull time

At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. We provide a flexible hybrid work model in which roles are designated as resident (on site 4-5 days/week), mobile (on site 1-3 days/week), or eworker (on site 0-3 days/month).

Blue Cross Blue Shield of Massachusetts, has a COVID-19 vaccination requirement for building entry. Your offer of employment is dependent upon either being fully vaccinated for COVID-19 or an accommodation based on a disability or sincerely held religious belief, practice, or observance by submitting a request to Human Resources.

Voted as the highest in member satisfaction among Massachusetts commercial health plans by JD Power , Blue Cross Blue Shield of Massachusetts is a community-focused, tax-paying, not-for-profit health plan headquartered in Boston. We have been a market leader for over 75 years, and are consistently ranked among the nation's best health plans. Our daily efforts are dedicated to effectively serving our 2.8 million members, and consistently offering security, stability, and peace of mind to both our members and associates.

Our Commitment to You

We are committed to investing in your development and providing the necessary resources to enable your success. We are dedicated to creating a refreshing and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path. We take pride in our diverse, community-centric, wellness-focused culture and believe every member of our team deserves to enjoy a positive work-life balance.

Blue Cross Blue Shield of Massachusetts is an Equal Employment / Affirmative Action Employer. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or expression, or any other characteristics protected by law.

Blue Cross Blue Shield of Massachusetts will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with Blue Cross Blue Shield of Massachusetts's legal duty to furnish information.

Customer Service Representative | Provider Service Division

Blue Cross Blue Shield of Massachusetts
Remote or Hingham, MA
Ready to help us transform healthcare? Bring your true colors to blue.

Customer Service Representative | Provider Service Division

$1,000 Sign-on Bonus! * Remote work available Full Time $20.00 / hour ($39,000 / year)

BCBSMA is seeking a new Customer Service Representative (Provider Service) for our elite Provider Services Division! The Provider Services Representative (Customer Service) will resolve telephone and written provider claims-related service inquiries. The Provider Services Representative (Customer Service) will be responding to our provider's benefit-related issues and questions, responding to questions on corporate policies and guidelines, timely filing, account receivables, claims processing, etc. The Provider Services Representative (Customer Service) will represent Provider Services in a positive and professional manner through appropriate telephone techniques and written responses.

RESPONSIBILITIES:

+ Assess, identify, and resolve provider inquiries in a timely and professional manner

+ Research and handle complex requests in an appropriate time frame with effective follow up

+ Review and manage personal inventory, in a timely manner, including aged inquiries

+ Communicate in a clear and concise manner to providers, peers and all levels of leadership

+ Contribute to the achievement of divisional and corporate goals including MTM

+ Comply with corporate, division, and team policies and guidelines

+ Educate providers on electronic technology and track trends for process improvements

+ Continually develop telephone techniques and research skills through self-assessment and constructive feedback

+ Monitor performance indicators in relation to individual, team, and divisional goals

+ Participate in workgroups and attend meetings to represent the division as required

+ Share innovative and creative solutions that result in increased levels of provider satisfaction

+ Foster a team based environment by participating in various activities that lead to associate support and provider satisfaction

QUALIFICATIONS:

+ Strong verbal and written communication skills

+ Quality and service-oriented demeanor

+ Effective listening and organizational skills

+ Demonstrate sound decision-making

+ Self-motivation, initiative, ability to handle multiple priorities and meet strict deadlines

+ Strong navigational skills with current knowledge of technology

+ Personal commitment to high quality performance through integrity, accountability, compassion, and teamwork

+ Ability to provide customer service designed to meet the customer's needs, showing empathy and the ability to apply reasonableness

EDUCATION/RELEVANT EXPERIENCE:

+ High school diploma or equivalent

+ BS/BA degree preferred or equivalent work experience

+ 2-3 years customer service experience

JOIN OUR TEAM TO ENJOY:

+ * $1,000 Sign-On Bonus! (The sign on bonus will be paid out in 4 installments of $250, after 3, 6, 9, and 12 months of employment. Associates must remain employed with the company in order to receive each of the installment payments.)

+ PAID TRAINING!

+ Recognition and rewards for high-performance and improvement

+ Internal career pathing with individual mentorship, networking and events

+ Employee resource groups for employees with shared backgrounds or the desire to learn more about their colleagues. All are welcome at our ERGs!

+ A dynamic work environment that keeps you thinking!

+ Best in class health, wellness, and retirement benefits among many others!

+ Performance based annual bonuses

+ Generous paid vacation time

The role is eligible for the following personas: E-worker, Resident & Mobile

If interested, you can expect an email within one day of application to begin the hiring process by taking an online assessment in the comfort of your home. This test will take you less than a half hour! After completion of the assessment, you will also receive a free Workplace Insights Report based on your individual results.

APPLY TODAY!

#LI-DNI

Minimum Education Requirements:

High school degree or equivalent required

LocationHinghamTime TypeFull time

At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. We provide a flexible hybrid work model in which roles are designated as resident (on site 4-5 days/week), mobile (on site 1-3 days/week), or eworker (on site 0-3 days/month).

Blue Cross Blue Shield of Massachusetts, has a COVID-19 vaccination requirement for building entry. Your offer of employment is dependent upon either being fully vaccinated for COVID-19 or an accommodation based on a disability or sincerely held religious belief, practice, or observance by submitting a request to Human Resources.

Voted as the highest in member satisfaction among Massachusetts commercial health plans by JD Power , Blue Cross Blue Shield of Massachusetts is a community-focused, tax-paying, not-for-profit health plan headquartered in Boston. We have been a market leader for over 75 years, and are consistently ranked among the nation's best health plans. Our daily efforts are dedicated to effectively serving our 2.8 million members, and consistently offering security, stability, and peace of mind to both our members and associates.

Our Commitment to You

We are committed to investing in your development and providing the necessary resources to enable your success. We are dedicated to creating a refreshing and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path. We take pride in our diverse, community-centric, wellness-focused culture and believe every member of our team deserves to enjoy a positive work-life balance.

Blue Cross Blue Shield of Massachusetts is an Equal Employment / Affirmative Action Employer. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or expression, or any other characteristics protected by law.

Blue Cross Blue Shield of Massachusetts will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with Blue Cross Blue Shield of Massachusetts's legal duty to furnish information.

Customer Service Representative | Member Service Division | February 2022

Blue Cross Blue Shield of Massachusetts
Remote or Quincy, MA
Ready to help us transform healthcare? Bring your true colors to blue.

Member Service Representative

$1,000 Sign-on Bonus! * Remote work available (MA candidates preferred) Full Time$ 20.00 / hour ($39,000 / year)

As the primary contact for our members, the Member Service Representative is one of the most important positions at Blue Cross Blue Shield of Massachusetts. Our ability to provide outstanding service to our members continues to be a top goal for every associate. Member Service Representatives work in a structured and supportive call center environment.

You must be able to attend a paid, phased nineteen-week new hire training program. During that time, our new team members move back and forth between the classroom and the lab/practice environment where you'll be taking member calls with extensive coaching and support. Your schedule is Monday through Friday. While in the classroom, you will work 9:00 am-5:00 pm. While in the practice environment taking member calls, your schedule may shift to a flex schedule. Your flex schedule which a range of shifts each 8 hours in length per day. Our Member Service associates can start their earliest shifts at 8:00am and finish some shifts as late as 6:30pm. The schedule patterns for each week can vary based on business needs however we are committed to giving our associates as much advanced notice as possible when this occurs.

Who We're Looking For

At Blue Cross Blue Shield of Massachusetts, we value our employees as much as our members. This job isn't for the faint of heart. No two members, problems, or resolution journeys are the same. Sometimes you won't know the right answer, but we're looking for someone who is always up for the challenge.

Our reps are the kind of people who create a plan and take charge in situations where others feel lost. If you excel at figuring out logic puzzles and logistics challenges outside of work, such as organizing sports tournaments or planning long road trips with multiple destinations, then we bet you have the right stuff!

We're looking for people best described as...

+ A proactive, solution-oriented decision maker

+ A planner, multi-tasker, and expert problem solver

+ Outspoken, with a "can-do" attitude and infectious positivity

What You'll Do In Your Role

As a Member Service Representative (MSR) at Blue Cross Blue Shield of Massachusetts you are in charge of solving members' problems and helping them get back to enjoying their lives as quickly and effortlessly as possible. You are empowered to provide members with peace of mind that their current issue is resolved and that none are on the horizon.

Successful MSRs deliver an effortless member experience by:

+ Taking the lead - our reps take ownership of members' issues, relieving members' stress while guiding them to a quick and easy resolution.

+ Identifying future problems - not only do our reps solve the current member concern but they actively identify and solve any lurking complications the member may encounter after their first interaction.

+ Sharing insights with peers and management - our positive team culture relies on open communication to continuously improve how our work gets done.

+ Having fun ! - our work is important, but we don't take ourselves too seriously. We love helping others and have a fun community dedicated to doing so!

Our Investment In You

Don't worry - you don't have to be an expert to become one! So long as you bring your passion for people and problem solving, we'll invest in you to take care of the rest. We'll provide fun, thorough and paid training that will teach you everything you need to know to feel confident handling member issues with a team of support by your side.

As a MSR, you are the face of our company, and at Blue Cross Blue Shield of Massachusetts we believe it's important to ask for our reps' input on anything from member solutions to workspace design.

Join our team to enjoy:

+ * $1,000 Sign-On Bonus! (The sign on bonus will be paid out in 4 installments of $250, after 3, 6, 9, and 12 months of employment. Associates must remain employed with the company in order to receive each of the installment payments.)

+ PAID TRAINING!

+ Recognition and rewards for high-performance and improvement

+ Internal career pathing with individual mentorship, networking and events

+ Employee resource groups for employees with shared backgrounds or the desire to learn more about their colleagues. All are welcome at our ERGs!

+ A dynamic work environment that keeps you thinking!

+ Best in class health, wellness, and retirement benefits among many others!

+ Performance based annual bonuses

Education/Relevant Experience:

+ High school diploma or equivalent required

+ BS/BA degree preferred or equivalent work experience

+ 2-3 years customer service experience

The role is eligible for the following personas: E-worker, Resident & Mobile

If interested, you can expect an email within one day of application to begin the hiring process by taking an online assessment in the comfort of your home. This test will take you less than a half hour! After completion of the assessment, you will also receive a free Workplace Insights Report based on your individual results.

APPLY TODAY!

#LI- DNI

Minimum Education Requirements:

High school degree or equivalent required

LocationQuincyTime TypeFull time

At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. We provide a flexible hybrid work model in which roles are designated as resident (on site 4-5 days/week), mobile (on site 1-3 days/week), or eworker (on site 0-3 days/month).

Blue Cross Blue Shield of Massachusetts, has a COVID-19 vaccination requirement for building entry. Your offer of employment is dependent upon either being fully vaccinated for COVID-19 or an accommodation based on a disability or sincerely held religious belief, practice, or observance by submitting a request to Human Resources.

Voted as the highest in member satisfaction among Massachusetts commercial health plans by JD Power , Blue Cross Blue Shield of Massachusetts is a community-focused, tax-paying, not-for-profit health plan headquartered in Boston. We have been a market leader for over 75 years, and are consistently ranked among the nation's best health plans. Our daily efforts are dedicated to effectively serving our 2.8 million members, and consistently offering security, stability, and peace of mind to both our members and associates.

Our Commitment to You

We are committed to investing in your development and providing the necessary resources to enable your success. We are dedicated to creating a refreshing and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path. We take pride in our diverse, community-centric, wellness-focused culture and believe every member of our team deserves to enjoy a positive work-life balance.

Blue Cross Blue Shield of Massachusetts is an Equal Employment / Affirmative Action Employer. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or expression, or any other characteristics protected by law.

Blue Cross Blue Shield of Massachusetts will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with Blue Cross Blue Shield of Massachusetts's legal duty to furnish information.

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Florida Blue - SA IV Contact QIP, Remote

Blue Cross Blue Shield of Florida
Remote or Florida
The role of Service Advocate is focused on servicing current or potential customers (which are defined as members, providers, agents, brokers, benefit administrators or benefits consultants). Incumbents resolve questions and issues, help the Company's customers utilize our products, tools and services and directly contribute to customer satisfaction and retention.
Essential Functions

* The essential functions listed represent the major duties of this role, additional duties may be assigned.
* The work of a Service Advocate IV is guided by practices, procedures, general work instructions and supervision of progress and results. These roles contain a greater variety of tasks and duties and on a daily basis incumbents clearly understand what results are expected by the supervisor. Incumbents are not permitted to deviate from standard practices and procedures, but may be permitted to set their own priorities, subject to supervisory approval. Incumbents perform moderately complex duties within established guidelines and may coordinate processes. Example job duties may include:
* Provide customer service to customers by answering the most complex benefit questions, researching and resolving issues, inquiries and exceptions and ensuring customers understand the Company's products and processes.
* Identify formal educational opportunities and needs and communicate these to the appropriate personnel.
* Provide information and guidance to customers regarding the selection of Company products, benefits and services.
* Support continuous improvement efforts through the early identification, investigation and resolution of problems by communicating and coordinating with the appropriate contacts for completion.
* May provide guidance and expertise to less experienced Service Advocates.

Required Work Experience

2 years related work experience or equivalent combination of transferable experience and education. Experience Details: Customer Service experience coupled with comuputer systems proficiency.

Required Education

High school diploma or GED

General Physical Demands

Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive and equitable culture for our employees and communities.

Florida Blue - SA IV Contact QIP, Remote

Blue Cross Blue Shield of Florida
Remote or Florida
The role of Service Advocate is focused on servicing current or potential customers (which are defined as members, providers, agents, brokers, benefit administrators or benefits consultants). Incumbents resolve questions and issues, help the Company's customers utilize our products, tools and services and directly contribute to customer satisfaction and retention.
Essential Functions

* The essential functions listed represent the major duties of this role, additional duties may be assigned.
* The work of a Service Advocate IV is guided by practices, procedures, general work instructions and supervision of progress and results. These roles contain a greater variety of tasks and duties and on a daily basis incumbents clearly understand what results are expected by the supervisor. Incumbents are not permitted to deviate from standard practices and procedures, but may be permitted to set their own priorities, subject to supervisory approval. Incumbents perform moderately complex duties within established guidelines and may coordinate processes. Example job duties may include:
* Provide customer service to customers by answering the most complex benefit questions, researching and resolving issues, inquiries and exceptions and ensuring customers understand the Company's products and processes.
* Identify formal educational opportunities and needs and communicate these to the appropriate personnel.
* Provide information and guidance to customers regarding the selection of Company products, benefits and services.
* Support continuous improvement efforts through the early identification, investigation and resolution of problems by communicating and coordinating with the appropriate contacts for completion.
* May provide guidance and expertise to less experienced Service Advocates.

Required Work Experience

2 years related work experience or equivalent combination of transferable experience and education. Experience Details: Customer Service experience coupled with comuputer systems proficiency.

Required Education

High school diploma or GED

General Physical Demands

Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive and equitable culture for our employees and communities.

Sr Full Stack Developer (Remote)

Blue Cross Blue Shield of Florida
Remote or Florida
We are interested in every qualified applicant who is eligible to work in the United States. However, we are not able to sponsor VISAs.
What Will Be Your Purpose?

You would be responsible for documenting detailed system specifications, participating in unit testing, and maintaining planned and unplanned internally developed applications, evaluation, and performance testing of purchased products. You would be expected to lead efforts, oversee work results, provide training, and serve as a technical resource for other Developers while providing hands on development on projects as part of the digital capabilities and performing the role of a technical lead.

What Will You Be Doing?

* Write code for complex system designs. Write programs that span platforms. Code to and/or create Application Programming Interfaces (APIs)
* Write code mostly for developing new programs
* Review code developed by other Developers
* Provide input to and drive programming standards
* Write detailed technical specifications for entire systems (made up of several subsystems). Identify integration points. Review technical specs created by other developers. Ensure sufficient quality and compliance of documentation to architectural standards
* Report missing elements found in system and functional requirements and explain impacts on subsystem to team members
* Consult with other Developers, Business Analysts, Systems Analysts and Project Managers
* Serves as lead liaison to vendors as assigned
* May serve on Steering Committees
* "Scope" time, resources, etc. required to complete programming projects. Seek review from other Developers, Business Analysts, Systems Analysts or Project Managers on estimates. Incorporate other Developer's scope information into own scope document (for integration points)
* Assist in reviewing vendor products. Provide SME input on compliance of products to architectural standards and impacts to IT environment
* Perform unit testing and debugging. Set test conditions based upon code specifications. Able to debug most program errors (simple to complex). May seek assistance from vendors to debug complex errors
* Support transition of application throughout the Product Development life cycle. Document what has to be migrated. Often requires more coordination points for transitioning systems. Document what has to be migrated / file properties
* Work on integration issues and determines the integration approach. Coordinate with other areas for integration architecture solutions
* Assist technical team with defining configuration for installing products. May consult on database setup. May load database for testing, especially if there are multiple tables.
* Review vendor research and gap analyses. Narrows down vendor choices and makes final recommendation to technical team and client
* Act as a technical mentor to other team members
* May act as a technical lead on projects as assigned

What We Prefer?

* Hands on experience with the following:
* DB2
* Postgres
* Mongo
* Java

* Software Development certifications

What You Must Have?

* 5 years related experience such as, IT development experience, full-stack development, etc.
* Related Bachelor's degree or additional related equivalent work experience
* Proven technical leadership in technical development, including mentoring, effective knowledge sharing, conflict resolution, facilitation of open discussions
* Strong experience coding in Node Js and React technologies with 100%
* Experience using Agile methodology
* Experience and understanding with unit testing, release procedures, coding design and documentation protocol as well as change management procedures
* Proficiency using versioning tools
* Ability to manage tasks independently and take ownership of responsibilities
* Ability to adapt to a rapidly changing environment
* Being a team player and work well with everyone in the team & organization.
* Excellent communication skills

The Federal Government and the Centers for Medicare & Medicaid Services (CMS) may require applicants to have lived in the United States for a minimum of three (3) out of the last five (5) years to be employed with the Company. These years of residence do not have to be consecutive.

Florida Blue is a federal contractor and as such will comply with federal guidelines related to the COVID-19 vaccination.

We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive and equitable culture for our employees and communities.

Sr IT Auditor - Remote

Blue Cross Blue Shield of Florida
Remote or Florida
The Senior IT Auditor is a staff professional who applies specialized knowledge, typically as an individual contributor, in assisting management and external auditors in matters that require audit experience. Incumbents utilize their professional audit knowledge, including theories, practices and techniques, to obtain appropriate audit support from internal business areas in a timely manner, answer external auditors' questions/requests, and maintain a repository of audit responses.
Essential Functions

* Utilizes an understanding of the Company's information technology environment and how systems support business activities to coordinate and/or conduct audits as assigned, including specialized activities.
* Provide support for the SOC 1 and SOC 2 report audits, and the annual financial statement audit, including performing direct assistance testing related to Information Technology General Controls.
* Execute key control testing through detailed analysis of various technical environments including operation systems, databases, network components and devices, and the related IT processes to manage those environments.
* Maintain audit request lists by distributing requests to appropriate Company personnel and reviewing the items provided to ensure that they meet the auditors' request.
* Conduct regular status meetings with the external auditors.
* Coordinate and/or attend meetings between external auditors and Company management/personnel.
* Maintain channels of communication and effective working relationships with all levels of management across all business areas in order to gaintheir support for audit processes.
* Perform other ad hoc assignments during off-peak external audit periods.

Required Skills:

* 3 years related work experience or equivalent combination of transferable experience and education OR 2 years of Big 4 experience (Deloitte, PwC, Ernst & Young or KPMG). From the 4 plus years or related work experience or equivalent combination at least one year of Audit experience is required.
* Related Bachelor's degree required Accounting, Accounting Information Systems, Computer Science or related field
* Ability to work towards the Certified Information Systems Auditor (CISA) designation.
* Understanding of Information Technology General Controls and operational processes, and experience auditing a variety of technical platforms, such as operating systems, databases, networks, firewall systems, and web services.
* Experience with report writing and data extraction using SAS, ACL, SQL, Microsoft Access, Excel or other report writing tools.
* Understanding of applicable regulatory and compliance requirements.
* Experience in auditing a variety of technical platforms, such as operating systems, databases, networks, firewall systems, web services, etc.
* Ability to maintain confidentiality regarding sensitive information.

Preferred Qualifications:

* Basic working knowledge of applicable regulatory and/or control frameworks (e.g., HIPAA, HITRUST, SOC 1, SOC 2, Model Audit Rule)
* Certified Information Systems Auditor (CISA)

General Physical Demands

* Sedentary work: Exerting up to 10 pounds of force occasionally to move objects.
* Jobs are sedentary if traversing activities are required only occasionally.

We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive and equitable culture for our employees and communities.

Florida Blue is a federal contractor and as such will comply with federal guidelines related to the COVID-19 vaccination.

Post/Pay Provider Audit RN - Remote Tampa Bay

Blue Cross Blue Shield of Florida
Remote or Jacksonville, FL
This is a senior-level technical position in the post-payment provider audit function intended to analyze assigned provider claims for risk of over and under payments to perform onsite and desk reviews in support of the business unit's objective to ensure all incorrectly billed and paid claims are adjusted accordingly to help control medical cost spend. This role requires clinical certifications and coding certifications to independently perform reviews of all assigned provider claims from a clinical, medical coding and provider billing perspective to ensure claims payment integrity. This will include reviews of corresponding medical records and clinical documentation to validate coding (specifically DRG) billing appropriateness. In addition, the role is responsible for ensuring claims are paid according to the provider and member contracts as well as ensuring that standard claims processing guidelines and billing procedures for each type of service and type of provider were followed. Additionally, this role is responsible for interacting directly with providers to coordinate onsite reviews and perform closing meetings with providers executives (CFOs, Managed Care VPs etc.) to present any findings that will result in claim adjustments.
Essential Functions:

The essential functions listed represent the major duties of this role, additional duties may be assigned.

Independently perform analysis of high-risk claims on a post-payment basis utilizing clinical, coding and claims processing background to ensure claims are coded, billed and paid correctly.

Leverage clinical and coding expertise to audit high risk claims for inappropriate application of associated Florida Blue policies and industry standard billing and care practices that may impact claims payment (e.g. MCG, LCD, Authorizations, Covered Benefits, Appropriateness of Service Setting). Specifically:

Request and review pertinent medical records to validate/invalidate potential issues identified on high-risk claims

Determine claim level financial impact based on unique member benefits and provider contract terms and payment policies.

Ensure claims processing compliance with overarching administrative regulations (Federal, State of Florida, BCBS Association etc.).

Perform claims level analysis of appropriate provider coding and billing practices and/or guidelines

Plan and maintain an individual audit schedule through coordination and communication directly with provider personnel for onsite reviews as necessary.

Thoroughly document identified issues to support claim adjustments (including supporting medical record, clinical or coding rationale).

Lead onsite closing meetings with provider executives to communicate and gain agreement on audit findings prior to claim adjustments. Communicate large/impactful audit findings to appropriate internal parties as needed.

Identify and document upstream process gaps driving incorrect payment for remediation and prevention

Required Work Experience:

5 years related work experience or equivalent combination of transferable experience and education. Experience Details: Strong familiarity with ICD-9/10, DRG, CPT/HCPCS coding, OR Experience with and knowledge of multiple provider reimbursement and pricing methodologies (DRG, SPC, OFS, POC, Global Pricing, Per Diem etc.), OR Demonstrated proficient working knowledge of at least three of the following: medical terminology, claim audit procedures, provider contracts, claims processing procedures and guidelines, provider authorizations, provider billing, medical coding, concurrent review, OR Proficient in Diamond

Required Licenses and Certifications:

RN - Registered Nurse - State Licensure and/or Compact State Licensure Active Florida RN license

Additional Required Qualifications:

Professional Medical Coding Certification (CPC, CCS, etc.)

The ability to travel frequently.

Proficiency/experience working with some of the following Tools/Apps: o Diamond o Jiva o APT o EIP o Siebel o ICN o Quest o Contract Management System o Burgess o PPS Pricer o AHA coding Clinic o Encoder o Alineo

Working knowledge of COB/OPL, Subrogation and Workers' Comp, standard claims adjustment processes and benefit plans.

Working knowledge of personal computer and related software (e.g., Excel, Microsoft Word).

Demonstrate flexibility in unplanned work and/or project support.

Excellent oral and written communications skills.

Professional Medical Coding Certification (CPC, CCS, etc.)

Up to 50% assignment travel in the Tampa Bay Area

Preferred Education

Master's degree

Additional Preferred Qualifications

* Strong analytics experience • Consulting experience

General Physical Demands

Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive and equitable culture for our employees and communities.

Data Analytics Consultant - Remote

Blue Cross Blue Shield of Florida
Remote or Florida
The Data Analytics Consultant will develop analysis and provide insights, analysis and reports. You will be accountable for identifying and quantifying key drivers for the Health Business, investigating areas of opportunity, evaluating effectiveness and making recommendations. Accountable for assisting leadership in evaluating key business drivers. Utilizing strong analytics, technical and communication skills as well as deep, broad understanding of the business to summarize key findings. Serves as a lead on projects and assists other team members by reviewing work, providing training and technical guidance.
The Skills You Will Bring:

* Manipulate data using large datasets and multiple data sources
* Act as primary Analyst for large projects and proactively identify topics for analysis
* Analyze or assist in the analysis of processes and programs in achieving stated goals. Provide analyses and recommendations if corrections are needed. Investigates and discovers areas of opportunity.
* Develop advanced Excel-based models and spreadsheets containing advanced functions that are used to evaluate historical trends and forecasts and to identify best practices.
* Write advanced SAS and/or SQL programs for data extraction. Integrate data across multiple areas. Modifies existing programs for data extraction
* Ownership, development and execution of Claims Operations queries, analytics, modeling and reporting. Personally develop and perform queries used to identify claims operations impacts on corporate financial results and Actuarial reserve process.
* Accountable for developing insightful and actionable summaries and recommending actions
* Monitor and evaluate patterns, costs and trends.
* Implement new analytical processes; partner with Information Management in the development of new analytical tools such as power pivots and analytical cubes to enhance analytical capabilities.
* Create and execute the data analytics and reporting strategy for Claims Operations relative to financial performance. Develop various reports in Excel, Word, and PowerPoint.

Required Skills:

* 6 years related work experience.
* Experience using algorithms and inferential statistics.
* Advanced level experience writing SQL /SAS or related code
* Advanced Excel skills
* Experience with health business
* Related Bachelor's degree or additional related equivalent work experience
* Proficient with Microsoft Office products
* Ability to manage tasks independently, take ownership of responsibilities and meet deadlines
* High critical thinking skills to evaluate alternatives and present solutions that are consistent with business objectives and strategy
* Demonstrated leadership abilities including effective knowledge sharing and conflict resolution
* Mastery of communicating highly complex information clearly and articulately for all levels and audiences

Preferred Skills:

* Bachelor's degree Business Analytics, Health Economics or similar program
* Master's degree in a related field
* Additional Preferred Qualifications
* Experience using risk adjusters

General Physical Demands

* Sedentary work: Exerting up to 10 pounds of force occasionally to move objects.
* Jobs are sedentary if traversing activities are required only occasionally.

We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive and equitable culture for our employees and communities.

Florida Blue is a federal contractor and as such will comply with federal guidelines related to the COVID-19 vaccination.

Sourcing Manager Procurement - Remote

Blue Cross Blue Shield of Florida
Remote or Florida
The Sourcing Manager requires talented, experienced, professionals with good business acumen, legal acuity, product knowledge, project management and organization skills. These skills, combined with a suite of competencies designed to successfully navigate the enterprise and vendor community, are necessary to produce well-constructed, mid to higher complexity solutions and contracts containing sound financials, balanced risk and measurable vendor accountabilities.

You must be a self-starter who requires minimal supervision in performing assigned tasks and has the ability to comprehend legal, financial and business concepts. Candidate will ensure that contracts and payment terms are negotiated in accordance with established Florida Blue contract administration policies and procedures, including all regulatory requirements. Prepares management reporting to summarize the status of contract negotiations and provides information to aid in management decision-making.
Essential Functions

* Interact and collaborate with internal stakeholders from Legal, Compliance, IT, Sales, Marketing and other functional business areas, as applicable
* Influence across all levels of management, including executive leadership
* Lead business requirement gathering sessions
* Document and prepare comprehensive bidding packages
* Represent Florida Blue as the single point of contact with potential suppliers during the RFP process
* Facilitate and lead onsite vendor presentations
* Develop and facilitate the use of formal scoring matrices to support vendor selection
* Maintain strict compliance with corporate policies and procedures relating to Business Ethics and Code of Conduct, in addition to the specific procurement regulations established by the Federal Government.
* Manage continuous process improvement by:
* Proactively identifying and taking action to improve the applicable procurement processes
* Identifying opportunities to increase internal business partners' education and alignment and acting on ideas
* Using and analyzing data to support improvement opportunities
* Utilizes professional specialized expertise in technical, legal, business, procurement and asset management disciplines for the acquisition of tangible and non-tangible assets
* With minimal supervision, determine the appropriate contracting approach to mid-complexity acquisition needs, as well as draft, present and negotiate all language within such contracts with stakeholders and vendors
* Possess a good working knowledge and understanding of legal, risk and business implications of contract language
* With minimal supervision, accurately ascertain, manage the associated due diligence regarding, and contractually address the implications of FEP, CMS, State Group, HIPAA, HITECH, etc. requirements on any asset acquisition activity
* Develop well thought out acquisition and negotiation strategies and execute with accuracy and agility
* Articulate, defend and present contracting strategies and approaches (of both parties) with business stakeholders and management as necessary to gain support and buy-in on negotiating strategies and efforts
* Construct professionally written executive summaries which articulate, in summary fashion, the initiative supported by the acquisition, the strategy, negotiation highlights, inherent risks and benefits, and financial landscape of mid-complexity contracting efforts
* Handle multiple assignments and achieve goals and deadlines in a fast-paced environment

Required Skills:

* 7 years related work experience.
* Successful contract negotiation experience in mid-complexity [Software], [Hardware], [Technology related Professional Services], [Business Process Outsourcing (BPO), [General Business Services] [Goods and Retail Products] acquisitions
* Related Bachelor's degree or additional related equivalent work experience related field
* Requires strategic as well as tactical knowledge of the RFP/Process Improvement to promote a change in procedural compliance.
* Understands principals of procurement and supply management
* Proven ability to drive organizational change
* Proven ability to influence across matrix and at all levels of management, including executive level
* Excellent written and verbal communication skills
* Proven ability to lead cross functional teams
* Excellent written and verbal communications skills with the ability to communicate effectively within an organization and diverse audiences
* Solid contract drafting and terminology knowledge that includes understanding of subtleties of contract language, risk based language, contracting traps and pitfalls to avoid, document management and control, and legal acuity necessary to successfully negotiate mid-complexity contracts
* For [Software], [Hardware], [Technology related Professional Services], possesses a good understanding of the IT Infrastructure related to computer hardware and software products to include servers, storage, networking, and software (including utilities, development and application)
* For [Technology related Professional Services], [Business Process Outsourcing], [General Business Services], possesses a good understanding of human sourcing methodologies to include Consulting, Staff Augmentation, and in-sourcing
* For [Business Process Outsourcing], possesses a good understanding of the business intricacies and details associated with establishing a BPO arrangement and accurately representing those details in the contract
* For [Goods and Retail], possesses a good understanding of best practices for contracting to acquire goods for the organization as well as consumer products for resale or for distribution and fulfillment arrangements including an excellent working knowledge of product liability issues
* Computer skills with the ability to utilize software applications required to perform job duties
* Detail and teamwork oriented with excellent organizational skills
* Ability to multi-task and handle several assignments concurrently while still meeting deadlines
* Ability to work independently, reviewing moderate to complex contract issues and recommending appropriate resolutions
* Ability to comprehend complex problems where analysis of situations or data requires an in-depth evaluation of various factors
* Strong organizational and time management skills.

Preferred Skills:

* Master's degree in a related field Or in Business

General Physical Demands

* Sedentary work: Exerting up to 10 pounds of force occasionally to move objects.
* Jobs are sedentary if traversing activities are required only occasionally.

We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive and equitable culture for our employees and communities.

Florida Blue is a federal contractor and as such will comply with federal guidelines related to the COVID-19 vaccination.

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