Medical Informatics Analyst, Principal
Blue Shield Job In California Or Remote
**Your Role** The Cost of Health Care Actuarial team is responsible for supporting the Pharmacy Reimagined strategy in addition to traditional actuarial functions of claim reserves and cost trends. The Pharmacy Medical Informaticist, Principal will report to the Senior Director, Cost of Health Care Actuarial. In this role you will support the Pharmacy Team's strategic objectives in contract negotiations, pricing for self-funded employer groups, formulary changes, product development, and initiative evaluation.
**Your Work**
In this role, you will:
* Use deep understanding of underlying business requirements to conceptualize and develop analytical systems that meet important business needs
* Design and develop these systems so that they can be used by lower-level analysts thereby promoting company-wide efficiencies
* Coordinate activities with other internal departments to maximize overall efficiency and resolve conflicts
* Communicate project status, progress, and outcomes to executive management
* Fulfill a leadership role in the critical review and ongoing development of data management and analytical systems for strategically important enterprise-wide analysis and reporting
* Support vendor financial contract performance evaluation, forecast and negotiation (e.g. rebates, network contracts)
* Support development of budget/trend impact models and formulary strategy models for high impact existing and pipeline drugs
* Provide Rx data support and participate in product governance /value assessment committee on Rx benefit and formulary strategy
* Support ASO product strategy evaluation and coordinate with UW and Actuarial Trend teams as needed
* Support RxCare strategic initiatives evaluation as needed
**Qualifications**
**Your Knowledge and Experience**
* Requires an MPH, MBA, MS, MA, RN, or RHIA in health science, quantitative social science, public health, health services research or business, or BA/BS with demonstrated equivalent work experience
* Requires SAS Certified Base Programmer Credential or equivalent and SAS Certified Advanced Programmer Credential or equivalent
* Requires at least 10 years of prior relevant experience
* Requires at least 5 years of experience in Health Care (managed care, academic, or gov't payer)
* Requires experience at a Pharmacy Benefit Manager (PBM)
**Pay Range:**
The pay range for this role is: $ 145970.00 to $ 218900.00 for California.
**Note:**
Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.
Blue Shield of California's mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.
Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California's top companies in volunteering and giving. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us!
**Our Values:**
* **Honest**. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
* **Human**. We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
* **Courageous**. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
**Our Workplace Model:**
At Blue Shield of California, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose - whether working in the office or through a hybrid approach - by providing clear expectations while respecting the diverse needs of our workforce.
Two Ways of Working:
* **Hybrid (Default):** Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above).Exceptions:
+ Member-facing and approved out-of-state roles remain remote.
+ Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.
+ For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
* **On-Site:** Work from a business unit-approved **office** an average of four (4) or more days a week.
**Physical Requirements:**
Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
**Equal Employment Opportunity:**
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
Role can be filled by a candidate requiring sponsorship No
Product Strategist, Consultant - Tandem & BlueHPN (Short-Term Employment)
Blue Shield Job In California Or Remote
**Your Role** The New Product team is responsible for product strategy, planning, development, and go-to-market of new and emerging products, including the development of novel plans, benefit structures, value-added services, customer experiences, networks, and health solutions capabilities. The Product Strategist, Consultant will report to the Product Manager, Principal. In this role you will support the development of product strategy, help manage product performance, and assist in the development and go-to-market of new Tandem and BlueHPN product initiatives.
Please note, this is a Short-Term Employment Opportunity.
**Your Work**
In this role, you will:
* Be responsible for evolving business line portfolios to deliver membership/OI targets and designing a competitive portfolio, accounting for acquisition, retention, and performance improvement
* Assist in architecting product strategy/plan designs based on benefit intent and functions as a central resource as products/plan designs move through the implementation life cycle
* Prepare materials in a story-board fashion, expressing concepts in a way easily understood by anyone who may not have the same background or expertise
* Assist in creation and interpretation of business product performance analytics to drive ongoing portfolio management and strategy
* Ensure delivery of innovation pipeline submissions from product line management, facilitating translation of product strategy to formal business requirements
* Develop Tandem and BlueHPN presentations, materials, and metrics for cross-functional partners, such as Sales and Operations
* Support Tandem and BlueHPN compliance with internal and external audits, mandates, and regulatory requirements
* Regularly monitor Tandem and BlueHPN product performance and escalate issues and recommend areas for improvement
* Conduct intermediate to advanced data analysis including use of pivot tables, charts, data tables, sensitivity analysis, financial modeling, and charting
**Qualifications**
**Your Knowledge and Experience**
* Requires a bachelor's degree or equivalent experience; Master's degree in business (MBA), public health (MPH), or other health care field and/or equivalent experience highly desirable
* Requires at least 7 years of prior relevant experience in product management and strategic planning concepts and practices
* Demonstrated experience working autonomously with business partner collaboration, reporting, analytics, and developing key performance metrics in complex environments
* Requires substantial knowledge and experience using tools such as Excel and PowerPoint
* Experience in health insurance and/or healthcare strongly preferred
* Effective verbal and written communication skills including the ability to create and deliver clear, powerful, and concise presentations/proposals and translating strategic and business goals into visual deliverables
**Pay Range:**
The pay range for this role is: $ 118800.00 to $ 178200.00 for California.
**Note:**
Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.
Blue Shield of California's mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.
Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California's top companies in volunteering and giving. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us!
**Our Values:**
* **Honest**. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
* **Human**. We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
* **Courageous**. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
**Our Workplace Model:**
At Blue Shield of California, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose - whether working in the office or through a hybrid approach - by providing clear expectations while respecting the diverse needs of our workforce.
Two Ways of Working:
* **Hybrid (Default):** Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above).Exceptions:
+ Member-facing and approved out-of-state roles remain remote.
+ Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.
+ For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
* **On-Site:** Work from a business unit-approved **office** an average of four (4) or more days a week.
**Physical Requirements:**
Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
**Equal Employment Opportunity:**
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
Role can be filled by a candidate requiring sponsorship No
Customer Service Associate Representative - Hybrid - Honolulu, HI
Remote or Urban Honolulu, HI Job
*************Must already live in Hawaii****************
Performs Customer Service duties under direct instruction and close supervision. Work is allocated on a day-to-day or task-by-task basis with clear instructions.
Entry point into professional roles.
Main job functions include:
Helping patients understand their pharmacy benefits better by using knowledge gained from training, problem-solving skills and added support from your team to answer patient calls effectively.
While on calls, you will use expert listening skills to address patient questions and concerns empathetically and document all interactions.
Assisting patients with prescription refills, scheduling shipments and addressing billing questions.
What You Should Have:
High School Diploma / GED required
1 year of relevant call center experience preferred
1 year Previous medical insurance or pharmacy experience preferred
General PC knowledge including Microsoft Office and outlook
Excellent communication skills (verbal and written)
Empathetic and genuine customer service skills
What you'll love about working here:
Fun, friendly, and unique culture
Choice of three unique medical plans
Prescription Drug, Dental, Vision and Life Insurance
Employee Contributions for HRA and HSA accounts
401K with Company Match
Paid Time Off and Paid Holidays
Tuition Assistance
Our Patient Care Advocates are dedicated team members who excel at customer service, helping us elevate our patient care to new heights. In this crucial role, you are on the front lines with patients, responding to phone inquiries and addressing each with care, detail, and most importantly, empathy.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
For this position, we anticipate offering an hourly rate of 17 - 18 USD / hourly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group.
About Evernorth Health Services
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Principal Project/Program Manager (Corporate Pharmacy)
Remote Job
Leads and manages the day-to-day operational and tactical aspects of all Medicare related pharmacy benefit management (PBM) activities, new initiatives, and other ongoing business deliverables in accordance with business needs. Identifies, evaluates, and resolves issues with PBM related deliverables. Resolves issues by utilizing facts, knowledge, and experience to steer towards favorable business outcomes. Serves as a trusted solutions advisor by developing strong stakeholder relationships. Collaborates closely with project team members, business owners and sponsors to develop and successfully implement projects/programs. Assesses ongoing performance risks and communicate trends to develop next best action. Oversees program to ensure initiatives have required resources, meets milestones, and are successfully implemented. Leads and coordinates matrixed and/or cross-functional team. Articulates complex concepts that can cause a roadblock and puts forward proposal to advance projects / programs.
**What You'll Do**
+ Develops project plans and recommendations in support of Corporate Pharmacy objectives and leads implementation; tracks and reports on the status of efforts related to our PBM. Must ascertain, categorize, and manage projects in relation to corporate priorities.
+ Negotiates resources to staff projects effectively with appropriate skill sets, aligning skills to the project's needs.
+ Delegates work as required and ensures a quality end product through close customer contact and assesses customer/client satisfaction through direct feedback/evaluation.
+ Coordinates development and implementation of policies and procedures as well as development of compliance measurements.
+ Controls and monitors project effectiveness; updates project plans, as necessary.
+ Ensures compliance with necessary audit requirements.
+ Represents Blue Cross NC in meetings with external parties including consultants, vendors, and others and may include service delivery management of vendors.
+ Assists with analysis and development of business processes to ensure quality, cost effectiveness, timeliness of customer service, and regulatory requirements and mandates are met.
+ Develops escalation process to channel issues and concerns to appropriate parties. Pre-empts and avoid conflicts using escalation paths effectively.
+ Evaluates program risks, developing contingency plans and responding to change in risk as initiatives progress.
+ Develops effective business process improvement initiatives and communication plans.
+ Performs analytic functions and coaches others in analytical production, technical and other areas.
+ Proposes a variety of solutions to business issues/problems utilizing appropriate analysis tools (i.e., Cost/Benefit Analysis, Flowcharting, etc.).
+ Documents and presents program management results through the development of criteria, issue analysis papers and reports; ensures that projects established objectives such as financial goals, where applicable and creates an evaluation plan to assess project performance in relation to stated goals.
+ Develops and tracks budgets, operating plans, and financial cost forecasts to support the program's objectives.
+ Provides indirect reports, if applicable, with well-defined expectations, ongoing feedback, coaching/ mentoring and/or training.
**What You'll Bring (Hiring Requirements)**
+ Bachelor's degree or advanced degree.
+ 5+ years of experience in related field.
+ In lieu of degree, 7+ years of experience in related field.
+ Direct experience leading and implementing pharmacy programs.
+ The ideal candidate will have extensive experience with PBMs.
**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._
$91,100.00 - $164,000.00
**About Us**
It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We're committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians.
Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all.
Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.
**Authorization to Work in the United States**
We use E-verify to confirm authorization to work in the United States. To learn more about E-Verify, including your rights and responsibilities, please visit E-Verify Overview (***************************************************** for English or Visión General de E-Verify (***************************************************************** for Español.
**Request Accommodations**
Blue Cross NC provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please notify HR at ********************** .
**For most roles, you can choose where to work - fully remote in one of the states listed below, in the office, or a hybrid of the two:**
Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming
Sr Strategic Policy Advisor
Remote Job
The Senior Strategic Policy Advisor will support Blue Cross NC and its subsidiaries in delivering health services to patient populations. This role involves leading the development, evaluation, positioning, and articulation of healthcare delivery policy positions. Additionally, the advisor will spearhead strategies related to internal and external policy, legislation, and regulation. Ensuring collaboration and consistency in external communication, positioning, and advocacy across the enterprise, the advisor will work closely with Government Affairs, Health Policy, and both the Blue Cross NC Core Insurance Groups and the Blue Cross NC Diversified Business Groups.
+ Lead the identification, evaluation and positioning of federal and state healthcare delivery policy, legislation and regulation impacting Blue Cross NC and its subsidiaries, including analyzing implications, facilitating internal and external feedback, driving position development, and serving as subject matter expert and consultant to business, subsidiaries, as well as public affairs, corporate communications, and compliance teams to support the development of solutions to policy, regulatory, legislative and political problems.
+ Manage internal cross-functional groups that research, review, determine the impact and make recommendations regarding legislative and regulatory issues before the NC General Assembly, the US Congress and state and federal agencies.
+ Provide strategic and external stakeholder intelligence on policy issues of key interest. Work directly with senior leadership to share information and develop positions.
+ Contribute to the development of a healthcare delivery policy agenda linked to the corporate vision, mission and strategy. Serve as a principal resource for educating all management levels of the company on health care delivery policy issues and implications to the business.
+ Responsible for development of commentary submissions and overall feedback representing perspective of Blue Cross NC and its subsidiaries for issues of potential legislative and regulatory influence directly and via trade associations.
+ Collaborate across the organization on the development of external communications and messaging on federal and state healthcare delivery policy, legislation and regulatory issues for Blue Cross NC and its subsidiaries, serving as content expert.
+ Support lobbyists with talking points, bill analysis, legislative language and necessary materials.
+ Draft position papers that accurately reflect the interests of Blue Cross NC's diversified business groups and its subsidiaries.
+ Monitor and participate in external collaborative legislative and regulatory policy efforts in order to support the shaping of state and federal healthcare delivery legislation and regulation.
+ Represent Blue Cross NC and its subsidiaries in working with federal and state industry and trade organizations, such as AAMC, American Hospital Association, NCMS, NCAFP, NCHA and others on political, legislative and regulatory issues of importance to Blue Cross NC and its subsidiaries.
**Hiring Requirements**
+ Bachelor's degree or advanced degree (where required)
+ 5+ years of experience in related field.
+ Deep understanding of healthcare delivery regulatory and legislative issues for both provider and hospital systems
**Hiring Preferences**
+ Exceptional written and verbal communication abilities to effectively convey complex information to diverse audiences.
+ Strong analytical skills to interpret and assess the impact of legislative and regulatory changes.
+ Proven ability to establish and maintain relationships with key stakeholders, including government officials, advocacy groups, providers and community organizations.
+ Ability to develop and implement long-term strategies that align with organizational goals.
+ Experience in advocacy and lobbying efforts, with a track record of influencing policy decisions.
+ Strong organizational skills to manage multiple projects and initiatives simultaneously.
+ Confidence and proficiency in public speaking to represent the organization at meetings, hearings, and events.
+ Ability to negotiate and mediate effectively to achieve favorable outcomes.
**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._
$100,500.00 - $182,700.00
**About Us**
It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We're committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians.
Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all.
Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.
**Authorization to Work in the United States**
We use E-verify to confirm authorization to work in the United States. To learn more about E-Verify, including your rights and responsibilities, please visit E-Verify Overview (***************************************************** for English or Visión General de E-Verify (***************************************************************** for Español.
**Request Accommodations**
Blue Cross NC provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please notify HR at ********************** .
**For most roles, you can choose where to work - fully remote in one of the states listed below, in the office, or a hybrid of the two:**
Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming
Care Coordinator I
Remote Job
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware
This position supports the workers- compensation claim operations and utilization management functions and acts as a liaison between claimants, providers, external claim representatives, clients and attorneys
Performs review of service requests for completeness of information, collection and transfer of non-clinical data, and acquisition of structured clinical data from physicians/patients.
Handles initial screening for precertification requests from physicians/claimants via incoming calls or correspondence based on scripts and workflows, and under the oversight of clinical staff.
Performs three-point contact, directs care into the network, follows up on status of treatment, corresponds with providers and documents the file consistently.
Coordinates the treatment plans proposed by providers, in accordance with established HCS protocols.
Upon collection of clinical and non clinical information CC can authorize medical treatment and associated diagnostic testing based upon scripts or algorithms used for pre-review screening.
Acts as liaison with client to identify issues and problems relating to care management and claim processing and forwards concerns to appropriate parties, when necessary.
Initiates calls and correspondence to claimants, providers, and the client to coordinate courses of treatment.
Perform other relevant tasks as assigned by management.
Education/Experience:
Prefers a bachelors degree.
Requires a minimum of two years business experience, preferably in a medical support related position or health insurance environment.
Additional licensing, certifications, registrations preferred
Knowledge:
Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Lotus Notes;
Should be knowledgeable in the use of intranet and internet applications.
Requires knowledge of medical terminology.
Prefers knowledge of understanding of case management, philosophy and process.
Skills and Abilities:
Strong typing, data entry and numeric keypad skills necessary.
Must be comfortable using a calculator for simple math calculations.
Analytical and Problem Solving Skills Customer Focus Interpersonal and Client Relationship Skills Communication (both verbal and written) and Organizational Skills Decision Making Flexibility/Adaptability
Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law.
Salary Range:
$55,400 - $74,130
This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:
Comprehensive health benefits (Medical/Dental/Vision)
Retirement Plans
Generous PTO
Incentive Plans
Wellness Programs
Paid Volunteer Time Off
Tuition Reimbursement
Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.
Corporate Social Responsibility Intern (NC Governor's HBCU Internship Program)
Remote Job
At Blue Cross NC, we are committed to making healthcare better for everyone. Our internship program is a cornerstone of our company culture, bringing in fresh perspectives and early-career talent to shape the future of healthcare. During your time with us, you'll contribute to meaningful projects and initiatives, work alongside innovative leaders, and make a real impact on our communities. Our hybrid-flex work environment allows you to thrive from home while also connecting in person with your cohort at our Durham campus during key events.
**What You'll Do**
For this internship opportunity we are looking specifically for a rising junior or senior **currently enrolled in a North Carolina Historically Black College and University (HBCU)** . Our Corporate Social Responsibility (CSR) (****************************************************************************************** Intern will support volunteer opportunities, develop, and write communications to promote volunteer opportunities (KABOOM! (******************** ), conduct research around CSR sustainability and other research as needed. Students with strong communications skills and/or volunteer development experience are strongly preferred. Some travel will be required to the Triangle area for volunteer events.
**What You Bring**
+ Must be a rising Junior or Senior at one of the following North Carolina Historically Black Colleges and Universities (HBCU) participating in the NC HBCU Governor's Program (****************************************************************************************************************************************************************** - **Elizabeth City State University, Fayetteville State University, Johnson C. Smith University, North Carolina Central University** or **Shaw University** in May 2025.
+ The NC Governor's Program requires aminimum cumulative GPA of 2.8.
+ You're available to work 40 hours per week for 10 weeks. (May 19 - July 25)
+ You will be located in North Carolina during the internship program.
+ Curiosity, drive, and the ability to work independently and in a team.
+ Great time management and communication skills.
**Bonus Points**
+ Knowledge of North Carolina and the nonprofit sector
+ Project Management
**Compensation**
+ Rising Junior/Senior: $21/hr.
**What Our Summer Internship Program Offers**
Your work over the summer will have a lasting impact on our company, our customers, and the communities we serve. You'll support and lead meaningful projects with passionate people from across our company who care about making a difference.
Our Summer Internship Program will be primarily virtual in 2025, and offers many opportunities for you to make connections, grow your skillset, and get involved through:
+ Paid internship experience working on meaningful projects
+ 16 paid well-being hours, in addition to paid company holidays
+ Networking opportunities with senior leaders
+ Onboarding to help you get familiar with health insurance, who we are as a company, and set you up for a successful summer
+ Access to online learning courses and resources to support your development
+ Individual mentoring with company leaders and young professionals
+ A cohort-style community where all interns across the company come together to learn, share, and network
+ Experience working at a certified Great Place to Work - enjoy our environment, culture, people, and perks
To learn more and check out blogs written by former interns, visit our Summer Internship Program website (****************************************************** .
**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._
$41,600.00 - $46,600.00
**About Us**
It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We're committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians.
Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all.
Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.
**Authorization to Work in the United States**
We use E-verify to confirm authorization to work in the United States. To learn more about E-Verify, including your rights and responsibilities, please visit E-Verify Overview (***************************************************** for English or Visión General de E-Verify (***************************************************************** for Español.
**Request Accommodations**
Blue Cross NC provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please notify HR at ********************** .
**For most roles, you can choose where to work - fully remote in one of the states listed below, in the office, or a hybrid of the two:**
Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming
Account Management (IC) Advisor - Hybrid - Express Scripts
Remote or Morris Plains, NJ Job
The Account Executive manages the overall contract and relationship with existing complex clients and their consultants. This position is the owner of the strategic renewal plan, development of long term account strategy and leads the growth & retention of current clients. The Account Executive is responsible for leading the identification of business solutions that meet client needs and incorporating such into the annual SPARC (Strategic Planning & Review Consultation) using their in depth knowledge and specialized expertise. They are also responsible for client retention, customer satisfaction and achieving corporate strategic goals relative to their book of business. The Account Executive serves as the client expert and a resource for others within the organization. They share best practices to contribute to development of others and provide forward-thinking leadership designed to move the business forward and lead projects/corporate initiatives.
ESSENTIAL FUNCTIONS
Sales Ability/Selling: Uses influence & persuasion to gain the support & commitment of others. Advocates and uses relationship building to obtain support. Convinces others to take action. Negotiates skillfully in tough situations. Responds effectively to positions/reactions of others. Efficiently & effectively sells solutions. Uses structured training to educate and influence clients, customers, & consultants.
Maximizes Results: Systematically manages accounts to maximize results. Consistently meets or exceeds sales targets through personally controlling the critical aspects of the sales and delivery processes. Leads & coordinates overall team effort. Driven to win customers' attention and treats their business as an honor, never letting them feel taken for granted. Produces by increasing profitable sales to existing accounts. Concentrates on finding avenues to generate increased sales from established accounts.
Uses broad knowledge of multiple business areas and the marketplace to advance the organization's goals. Knows how the business works and how organization makes money. Keeps up with current and possible future policies, practices, innovations, and trends in the organization, with the competition, and in the marketplace. Conducts/Uses financial analysis to generate, evaluate, and act on strategic options and opportunities. Has clinical knowledge and can apply understanding in interactions with clients.
Customer Focus: Builds strong customer relationships & delivers customer-centric solutions. Gains insight into customer needs and helps ensure a better member experience. Identifies opportunities to benefit the customer. Builds/Delivers solutions that meet the customer's expectations. Builds and maintains effective customer relationships. Balances short & long term relationship needs to effectively execute renewal strategy & organic growth. Gains the confidence & trust of others through honesty, integrity, authenticity, & reliability.
Communicates Effectively: Develops and delivers multi-mode communications that convey a clear understanding of the unique needs of different audiences. Is effective in a variety of communication settings. Attentively listens to others and adjusts message as needed. Adjusts to fit the audience and the message. Provides timely and accurate information to others. Promotes customer relations by soliciting feedback both internally and externally. Proactively anticipates communication needs in order to remove ambiguity.
Manages Complexity: Makes sense of complex, high quantity, & sometimes contradictory information to effectively solve problems. Asks the right questions to accurately analyze situations. Acquires data from multiple sources and collaboratively works cross functionally when solving problems and creating solutions. Uncovers root cause of issue. Evaluates risks/benefits of different solution options. Anticipates & balances the needs of multiple stakeholders, recognizing & addressing different communication styles. Secures & deploys resources effectively & efficiently.
QUALIFICATIONS
Bachelor's degree in related field or 14-18 years of experience.
8-12 years of relevant experience with Bachelor's degree or Master's degree with 6-10 years relevant experience.
Strong PC skills including Microsoft Word, Excel, and PowerPoint; Working knowledge of financials.
Strong Project management skills.
Superior verbal and written communication and presentation skills.
Ability to negotiate, lead others, organize, analyze and interpret information.
Ability to travel as needed to meet goals.
Market Range : $82,500 - $137,500
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
**About Evernorth Health Services**
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.
_Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws._
_If you require reasonable accommodation in completing the online application process, please email:_ _*********************_ _for support. Do not email_ _*********************_ _for an update on your application or to provide your resume as you will not receive a response._
_The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State._
_Qualified applicants with criminal histories will be considered for employment in a manner_ _consistent with all federal, state and local ordinances._
Risk Control & Premium Audit Director (hybrid/remote)
Remote or Columbus, OH Job
It's ok if you don't meet every requirement. At Grange, we prioritize creating a diverse, equitable and inclusive workplace. If you're enthusiastic about this role but your previous experience only partially matches qualifications in the job description, we still encourage you to apply. We believe in fostering growth and providing opportunities for continuous learning and development of skills as you progress in your career with us.
Summary: This position is responsible for developing Commercial Risk Management strategy and leading our enterprise Risk Control and Premium Audit teams. Setting operational expectations and driving results through leadership, development and engagement.
What You'll Be Doing:
* Develops strategic direction and operational plans for Risk Control and Premium Audit department to achieve business plans.
* Oversees operations for our current state footprint, with responsibility of aligning our Commercial Risk Management and Premium Audit strategies to support future state expansion.
* Establishes clear objectives and practice standards for the team. Ensures that methodologies and outcomes meet business and strategic objectives.
* Develops partnerships with key agencies for the Grange Enterprise, leading to stronger risk management solutions and portfolio growth.
* Determines and ensures delivery of training and development based on individual and department needs. Coaches, develops and provides feedback to associates
* Oversees new innovative service offerings, technology, and digital risk management solutions that enhances the value proposition for agents and customers
* Oversees all reporting and data needs, scorecards, and business intelligence efforts for the Risk Control department.
* Maintains relationships and represents department with internal and external business partners (e. g. underwriting, sales, claims, agents, policyholders, etc. ).
* Ensure execution of strategic plans into organizational direction. Creates business plans, goals, budget and timelines to meet company standards.
* Directs associates and provides performance management, salary planning and administration, organizational planning, hiring and placement, and disciplinary actions.
What You'll Bring To The Company:
* Minimum of 10 years of experience in risk control and/or premium audit preferred, plus a minimum of 5 years' leadership experience in risk control within commercial insurance.
* Bachelor's degree in safety, science, engineering, fire science or business management preferred. Advanced degree in business or safety management preferred.
* Prefer a minimum of one of the following designations, such as: Certified Safety Professional (CSP), Certified Director of Safety (CDS), and Associate of Risk Management (ARM).
* Expert knowledge of safety and risk management practices and principles including regulatory (OSHA, DOT, etc.) and national consensus codes (NFPA, etc.).
* Understanding of the commercial insurance business process and the fundamental role of Risk Control in that process.
* Knowledge of sales prospecting and business retention as well as an understanding of applicable state and federal regulations.
* Ability to set strategic goals and priorities.
* Demonstrated decision-making ability required in day-to-day operations where there may be unclear or competing priorities, including evaluating and recommending solutions to customer service issues, work processing issues and best practices compliance.
* Strong analytical skills and drive for results.
* Skilled communicator with strong people leadership, engagement and development skills.
* Must have a valid drivers' license and acceptable driving record.
About Us:
Grange Insurance Company, with $3.2 billion in assets and more than $1.5 billion in annual revenue, is an insurance provider founded in 1935 and based in Columbus, Ohio. Through its network of independent agents, Grange offers auto, home and business insurance protection. Grange Insurance Company and its affiliates serve policyholders in Georgia, Illinois, Indiana, Iowa, Kentucky, Michigan, Minnesota, Ohio, Pennsylvania, South Carolina, Tennessee, Virginia, and Wisconsin and holds an A.M. Best rating of "A" (Excellent).
Grange understands that life requires flexibility. We promote geographical diversity, allowing hybrid and remote options and flexibility in work hours (role dependent). In addition to competitive traditional benefits, Grange has also created unique benefits based on employee feedback, including a cultural appreciation holiday, family formation benefits, compassionate care leave, and expanded categories of bereavement leave.
Who We Are:
We are committed to an inclusive work environment that welcomes and values diversity, equity and inclusion. We hire great talent from various backgrounds, and our associates are our biggest strength. We seek individuals that represent the diversity of our communities, including those of all abilities. A diverse workforce's collective ideas, opinions and creativity are necessary to deliver the innovative solutions and service our agency partners and customers need. Our core values: Be One Team, Deliver Excellence, Communicate Openly, Do the Right Thing, and Solve Creatively for Tomorrow.
Our Associate Resource Groups help us create a more diverse and inclusive mindset and workplace. They also offer professional and personal growth opportunities. These voluntary groups are open to all associates and have formed to celebrate similarities of ethnicity/race, nationality, generation, gender identity, and sexual orientation and include Multicultural Professional Network, Pride Partnership & Allies, Women's Group, and Young Professionals.
Our Diversity, Equity and Inclusion Council, created in 2016, is focused on professional development, networking, business value and community outreach, all of which encourage and facilitate an environment that fosters learning, innovation, and growth. Together, we use our individual experiences to learn from one another and grow as professionals and as people.
We are committed to maintaining a discrimination-free workplace in all aspects, terms and conditions of employment and welcome the unique contributions that you bring from education, opinions, culture, beliefs, race, color, religion, age, sex, national origin, handicap, disability, sexual orientation, gender identity or expression, ancestry, pregnancy, veteran status, and citizenship.
Grange Enterprise is proud to be part of the CEO Action for Diversity and Inclusion, a national initiative of more than 1400 CEOs working for the advancement of diversity and inclusion within the workplace.
Strategic Account Executive - Hybrid or Remote
Remote or Columbia, SC Job
Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we've been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!
Description
Position Purpose:
Responsible for the sales, service, and administrative activities and relationship management to prospective and existing accounts. Customarily and regularly engaged in outside sales.
Responsible for relationship management with Partner Blue Plans and support issue resolution for escalated items.
Responsible for analyzing utilization and program participation data and presenting to external audiences.
Responsible for understanding market trends, how our ancillary programs and capabilities support and to serve as a subject matter expert to present to external audiences.
Responsible for mentoring and providing leadership to all team members supporting partner plan and account relationships and servicing.
Logistics:
This is a full-time position working (40-hours/week) Monday-Friday 8:00am - 5:00pm working a hybrid or remote position; 3 days onsite (Monday and Thursday required onsite) and 2 days remote at 4101 Percival Rd. Columbia SC, in an office environment. *Will consider remote for candidates outside of South Carolina.
What You'll Do:
Responsible for renewal and management of existing accounts. Maintains strong service relationships with clients and agents. Research/compiles presentations and sales materials as needed. Coordinates client and agent input into renewal process. Obtains client signoff on administrative service agreements.
Responsible for renewal reporting. Gathers and analyzes data from client and/or agent to compile, approve and deliver marketing packages. Manages related communications relating to existing account renewals. Provides ongoing account management.
Responsible for development of new account sales. May work with marketing area to execute marketing strategy for new business in assigned territory/relationship network. Compiles, approves and delivers presentations and presents proposal packages for new groups. Obtains client signoff on administrative service agreements.
To Qualify for This Position, You'll Need:
Required Education: Bachelor's in a job related field
Degree Equivalency: 4 years job related work experience or Associate's and 2 years job related work experience
Required Work Experience: 7 years healthcare insurance/program management, customer service, and/or technology-related industry. 2 of the 7 years must have been in direct sales and marketing role in one or more of the areas listed.
Required Training: Department of Insurance Licensure must be obtained within 60 days of hire in state employed.
Required Skills and Abilities: Knowledge of sales principles and techniques. Ability to work independently, prioritize effectively, and make sound decisions. Good judgment skills. Effective customer service, presentation, and organizational skills. Analytical or critical thinking skills. Basic business math proficiency.
Required Software and Other Tools: Microsoft Office.
Required Licenses and Certificates: Department of Insurance Licensure must be obtained within 60 days of hire in state employed.
Work Environment: Typical office environment. Involves travel between office buildings. Involves frequent out of town travel. Work may involve transportation of materials and periods of remaining in a stationary position.
What We can Do for You:
We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.
Subsidized health plans, dental and vision coverage
401K retirement savings plan with company match
Life Insurance
Paid Time Off (PTO)
On-site cafeterias and fitness centers in major locations
Wellness program and healthy lifestyle premium discount
Tuition assistance
Service recognition
Employee Assistance
Discounts to movies, theaters, zoos, theme parks and more
What to Expect Next:
After submitting your application, our recruiting team members will review your resume to ensure your meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. If the qualifications required proof of semester hours, please attach your transcript to your application.
Management will be conducting interviews with the most qualified candidates, with prioritization give to those candidates who demonstrate the preferred qualifications.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.
Some states have required notifications. Here's more information.
Equal Employment Opportunity Statement
BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.
We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.
If you need special assistance or an accommodation while seeking employment, please e-mail ************************ or call **************, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.
Clinical Documentation Specialist MHP
Remote Job
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware
This position is responsible for working independently to ensure documented operational compliance to state, federal, and accreditation standards in Utilization Management and/or Case Management as related to mental health parity. Is the Regulatory Mental Health Parity clinical department subject matter expert in UM regulatory compliance requirements of MHPAEA, DOBI, IPRO, State, CMS and NCQA. Makes recommendations on process improvements/changes required to comply with regulatory standards. The individual creates and maintains library of policies, workflows, and audit documentation related to Mental Health Parity and CMS clinical requirements. Track and trend operational deficiencies identified by internal and external regulatory/accreditation audit and identify and implement opportunities for improvement. Responsible for training and education as applicable to staff related to regulatory standard updates.
In addition, the position collaborates with clinical areas and legal/ Compliance/reregulate to understand business implications and impacts to workflows, policies, and operations as a result of regulatory changes or laws. The individual prepares business correspondence, audit action plans, and reports, as well as maintain and improve the multiple policies and procedures that must operate in parity to ensure compliance with relevant regulatory compliance requirements. The incumbent is responsible for preparing and presenting policies and procedures that impact compliance with mental health Parity, NQTLs, and its corresponding factors to clinical committees. This individual is responsible for assuring that all clinical staff are trained and apply all Mental Health Parity and CMS regulatory clinical standards appropriately to assure clinical staff compliance in both the Physical and Behavioral Health Clinical Departments.
Responsibilities:
Act as the Clinical Subject Matter Expert (SME) with in collaboration with Legal, Regulatory, Compliance, Quality and other departments as applicable on contract changes and regulatory audit compliance applicable to UM and CM as related to Mental Health Parity.
Lead cross-functional work streams and compliance pertaining to mental health parity and the regulation of mental health and substance use disorder benefits.
Lead the development of policies and analyses supporting the Company's ongoing compliance with state and federal parity requirements. This will include cross-functional collaboration with actuarial on quantitative treatment limitation analysis, as well as collaboration with HNS and other managed care functions and non-quantitative treatment limitations.
Responsible for modifying and enhancing educational and training UM and CM materials related to the regulation of mental health and substance use disorder benefits, and other key policy developments impacting the operation of individual, group, and governmental health plans.-Lead for staff education and training related to MHPAEA /NCQA/DOBI/IPRO/CMS standards and related audit findings.
Analyzes complex data and information to provide meaningful results, identifying success factors and improvement opportunities, recommending potential solutions to assist the business set strategic goals.
Review non-standard benefits for compliance with applicable regulatory compliance laws
Subject matter expert (SME) for MHPAEA, State, DOBI, IPRO, CMS, NCQA and internal audit preparation and review on the company benefit products (Medicaid, Medicare, Commercial) to assure consistency and compliance of subscriber/member contracts, provider agreements, and other regulated contracts, with respect to benefit and network administration, and other Company operations. Work closely with Contract Administration and Product Administration to assure that new benefit products or strategies align with regulatory compliance requirements.
Prepare comparative analysis of written operational policies and on-going qualitative and quantitative analysis to monitor the NQTL factors compliance. Track and Trend data on audit deficiencies and identify and implement opportunities for improvement.
Assist the clinical areas with regulatory audit preparation, provide guidance on findings, and prepare plan response to audit findings.
Responsible for implementation of department Corrective Action Plans associated with external audit findings.
Identify opportunities to align policies across all lines of business and between Physical Health and Behavioral Health UM and CM teams.
Educate on policy and contract changes and ensure applicable operational procedures/ job aids are updated for compliance.
The information above is intended to describe the general nature of the work being performed by each incumbent assigned to this position. This job description is not designed to be an exhaustive list of all responsibilities, duties, and skills required of each incumbent.
Education/Experience:
Bachelor's or Master's preferred, in a healthcare degree from an accredited college or university.
Requires a minimum of 5 years of business experience, preferably in the health insurance industry in a clinical role or as a health policy advisor.
Requires minimum of 2 years of providing regulatory guidance (analyzing and interpreting laws and regulations) or compliance experience, preferably in health insurance focus on Mental Health Parity and NQTL audit responses.
Experience with health insurance contract preparation and/or employee benefits plan drafting is preferred.
Additional licensing, certifications, registrations:
Clinical licensure preferred (RN, LPC, LCSW)
Knowledge:
Requires general business knowledge of the health insurance industry
Regulatory Compliance at the State and Federal level
Mental Health Parity knowledge/background required
Requires knowledge of Utilization management in Managed Care
Prefer working knowledge of health benefits plans, state and federal laws and regulations as they apply to group contracts, federally funded governmental healthcare programs, insurers and familiarity with state departments of Insurance and/or Health
Skills and Abilities:
Requires advanced analytical skills and the ability to present/recommend business solutions
Requires excellent organizational and prioritization skills
Requires the ability to work and communicate effectively with all levels of business, including senior and executive leadership
Requires excellent oral and written communication/presentation skills
Effective analytical & problem solving skills to propose creative solutions to regulatory needs
Collaborative and client service focused to effectively deliver actionable requirements and solutions
Must demonstrate professional and ethical business practices and adherence to company standards
Must demonstrate the ability to effectively present information and respond to questions from groups of managers, internal and external clients, and company customers
Must demonstrate the ability to learn quickly and apply learning to new situations. Must exhibit flexibility to adapt to new regulatory requirements and compliance regimes as appropriate
Demonstrated proficiency in Microsoft Office Suite
Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law.”
Salary Range:
$76,800 - $102,795
This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:
Comprehensive health benefits (Medical/Dental/Vision)
Retirement Plans
Generous PTO
Incentive Plans
Wellness Programs
Paid Volunteer Time Off
Tuition Reimbursement
Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.
Revenue Growth Sales Director - Verity Solutions - Remote
Remote Job
Job Objective:
We are seeking a dynamic and results-oriented Sales Director to execute market penetration plans for key software solutions to grow sales and drive revenue growth. In this role you will be responsible for identifying, developing and closing sales opportunities for our innovative software solutions that address critical challenges faced by healthcare providers. You will be responsible for building relationships with key decision makers at IDN's, large Healthcare Systems and FQHC facilities.
Duties and Responsibilities:
Grow the Verity customer base and drive product sales to meet Company revenue objectives.
Conduct in-depth needs assessments to understand customer pain points and tailor solution presentation accordingly.
Effectively communicate the value proposition of our software solutions, highlighting the benefits and ROI.
Deliver compelling product demonstrations and presentations to C-suite executives and clinical leaders.
Build and maintain strong, long-term relationships with key accounts.
Negotiate contracts and pricing to maximize revenue and profitability.
Work collaboratively with the Strategic and Community sales team to lead the sales strategy and provide demo support on key focus products.
Work with inside sales to prospect and engage with new leads through targeted email campaigns.
Leverage Verity's CRM application Salesforce to effectively manage your forecast and pipeline while adhering to the defined steps in in the Verity Sales process.
Assist marketing and sales leadership in webinars and other prospecting events.
Provide support to Verity's response team for RFP's on key strategic accounts.
Represent Verity Solutions at industry events and conferences.
Stay current with industry trends, regulatory changes, and competitive landscapes within the 340B and healthcare market.
Experience, Skills and Qualifications:
BA or BS or equivalent experience.
Must have 5+ years of software sales or healthcare market experience. 340B knowledge and experience is a plus.
Strong presentation and demo skills with articulate, clear messaging.
Ability to build rapport and trust with C-suite executives and other decision makers.
Experience working collaboratively in a team sales environment.
Excellent verbal and written communication skills with demonstrated ability to communicate effectively.
Strong MS Office Experience.
Strong experience with Salesforce or a similar CRM.
Ability to compile, analyze and report on commons sales metrics.
Detail oriented and strong organization skills.
Proven track record of success in software solutions sales within the healthcare industry.
Strong negotiating and closing skills.
Experience working in a goal oriented, delivery focused, and dynamic environment.
Willingness to travel as needed.
Working Conditions:
The job conditions for this position are in a standard home office setting. Employees in this position use PC and phone on an on-going basis throughout the day and are expected to present a professional online presence in video conferencing. Travel is expected to be up to 75% of the time.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
This role is also anticipated to be eligible to participate in an incentive compensation plan.
We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group.
About Evernorth Health Services
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
Government & Education Advisor (Hybrid/North Florida)
Remote or Jacksonville, FL Job
The Government & Education (G&E) Advisor is responsible for taking actions that result in public sector membership growth & success. This role will serve as a key partner to local market sales teams to develop and evolve the government and education sales and retention strategy within specific aligned market areas. As a subject matter in the public sector, this role requires significant external relationship building. This role will report to the G&E Senior Advisor with a dotted line to the applicable Market Growth Leader(s) to which they are aligned.
Key Responsibilities:
* Activates our public sector sales distribution strategy within aligned markets.
* Builds and maintains the necessary partnerships and relationships to grow and retain our public sector business within specific market alignments.
* Contributes to pipeline/prospect development in conjunction with the local market sales leadership - with keen focus on targeting prospects that are viable candidates to win.
* Reports/advises on pipeline development and activities that are advancing the sales process - with a focus on conveying key needs of the segment to support the sales process.
* Engagement with segment underwriting, legal, and product leadership where appropriate.
* Consistent engagement with RFP Proposal Response Team to ensure superior RFP product.
* Involvement with market strategic planning/business development meetings within specific market alignments.
* Serve as a liaison between local market leadership and G&E leadership to help inform and balance the priorities and focus of the local market and the segment.
* Maintains a deep understanding of the unique government dynamics and competitive landscape of each geographic market and applicable changes.
* Builds the long-term pipeline within specific market alignments in pursuit of:
* New medical and dental public sector accounts >3,000 employees.
* First time medical adds to assigned large/existing dental only accounts > 3,000 ees.
* Retention of assigned large existing accounts > 3,000 employees out to bid
* Articulate the value proposition of Cigna healthcare to current & prospective public sector clients.
* Point of contact for all matters related to procurement with new and existing customers.
* Engagement with broker/consultants as needed (pre/post RFP) in partnership with local market sales leadership. Development of diverse supplier relationships where applicable.
* All direct to client pre-RFP work that will influence Cigna's position and understanding of government and education prospects, including but not limited to:
* Meetings with HR, Finance, Senior Management officials.
* Engagement with union employee leadership.
* Meetings with influential elected officials; meetings with influential community partners if appropriate; development of minority vendor strategies if appropriate; engagement and management of local lobbyists/advisors as appropriate.
* Development and management of local association relationships; engagement with targeted regional and/or national association relationship important to the public sector.
* Management of Freedom of Information requests. Important to maintain coordinated pre-RFP strategy with local market sales leadership.
* Targeted sales and retention engagement with any other government prospect as necessary.
Qualifications:
* Minimum 6 years of sales experience, account management, and/or business development experience health care or insurance industry preferred. This experience should include many or all of the following: product knowledge, underwriting, risk and financial analysis skills, marketing processes, sales practices, account management and knowledge of administrative operations.
* Exposure to and/or understanding of local government procurement and/or elected official relationship dynamics is preferred.
* Bachelor's degree or equivalent related work experience.
* Health and life insurance license required.
* Experience selling to local governments and or school districts is preferred.
* Proven ability to influence, with strong communications and a a proven ability to establish and build relationships.
* Demonstrated ability to develop strong matrix partner relationships.
* Strong customer focus.
* Strong ability to collaborate, with a track record of delivering results that lead to success.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
About Cigna Healthcare
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
Internal Auditor II- Compliance
Remote or Nashville, TN Job
Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we've been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!
Description
Position Purpose:
Responsible for providing a full range of financial, compliance, and operational audits, business advisory and consultation services, investigations, internal controls, accountability, and use of resources.
Logistics:
This position can be 3 days in office in Nashville, TN, or Columbia, SC and 2 days' work from home. Please note this is subject to change based off of employee performance and/or business needs.
What You'll Do:
Conducts internal and external timely operational, compliance, and financial audits of divisions, departments, providers, and activities of the corporation including evaluation of internal controls. Identifies, documents, and evaluates business risks. Documents issues, the causes of those issues, and their effects on the process/function and the corporation.
Drafts recommendations to limit risks and improve processes, functions and activities. Writes audit reports for corporate executive management that clearly and effectively convey engagement evaluations, conclusions, and recommendations. Collects and analyzes data to detect deficient controls, duplicated effort, fraud, or non-compliance with laws, regulations, and management policies. Conducts testing of corrective actions as identified.
Develops detailed reports on each audit conducted. Reports include a review of findings and an identification of recommendation to correct any deficiencies and methods for improvement to processes. Examines and evaluates financial and information systems, recommending controls to ensure system reliability and data integrity.
Conducts special audit studies for management, such as those required to discover controls for prevention of fraud. Prepares reports of findings and recommendations for management.
Assists other auditors in completing their assignments as a means of maximizing audit efficiency and thus reducing lost time and involvement of corporate personnel.
To Qualify for This Position, You'll Need:
Required Education:
Bachelors in a job-related field.
Required Work Experience:
3 years auditing experience.
Required Skills and Abilities:
Knowledge of the principles and practices of auditing.
Ability to analyze and determine the applicability of financial data.
Ability to draw conclusions and make appropriate recommendations for analyzed data.
Ability to gather information by examining records and documents and interviewing individuals.
Strong interpersonal skills.
Ability to maintain effective working relationships.
Ability to communicate clearly and effectively in oral and written form.
Ability to handle sensitive matters on a confidential basis.
Required Software and Tools:
Microsoft Office.
Preferred Licenses and Certificates:
Certified Internal Auditor (CIA) or Certified Public Accountant (CPA) or Certified Information Systems Auditor (CISA)
Work Environment:
Typical office environment. Travel between office buildings occasionally may be required. Out of town travel may be required.
What We can Do for You:
We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.
Subsidized health plans, dental and vision coverage
401K retirement savings plan with company match
Life Insurance
Paid Time Off (PTO)
On-site cafeterias and fitness centers in major locations
Wellness program and healthy lifestyle premium discount
Tuition assistance
Service recognition
Employee Assistance
Discounts to movies, theaters, zoos, theme parks and more
What to Expect Next:
After submitting your application, our recruiting team members will review your resume to ensure your meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. If the qualifications required proof of semester hours, please attach your transcript to your application.
Management will be conducting interviews with the most qualified candidates, with prioritization give to those candidates who demonstrate the preferred qualifications.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.
Some states have required notifications. Here's more information.
Equal Employment Opportunity Statement
BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.
We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.
If you need special assistance or an accommodation while seeking employment, please e-mail ************************ or call **************, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.
Intern - Strategy and Innovation
Remote Job
Job Qualifications
Education
Active college student (in an accredited college or university) who has completed a minimum of two years of college are eligible.
Recent college graduates and students enrolled in a Masters or Doctoral program (in an accredited college or university) are also eligible.
Must provide transcripts.
Active full-time BCBST employees are not eligible to participate in the program.
Experience
Varies based on line of business. Please see Job Specific Requirements section below for this internship's specific responsibilities and preferred qualifications.
Skills/Certifications
Able to prioritize, work independently, and effectively manage time and resources.
Effective communication skills: written and verbal.
Proficient computer skills and Microsoft Office experience (Outlook, Word, Excel and PowerPoint)
Appropriate decision making skills required.
GPA requirement
Must have a 2.75 GPA or higher
Preferred Majors and GPA:
Finance and Accounting majors preferred.
GPA: 3.0
Number of Openings Available:
1
Worker Type:
Intern (Trainee)
Company:
BCBST BlueCross BlueShield of Tennessee, Inc.
Applying for this job indicates your acknowledgement and understanding of the following statements:
BCBST is an Equal Opportunity employer (EEO), and all employees and applicants will be entitled to equal employment opportunities when employment decisions are made. BCBST will take affirmative action to recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.
Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:
BCBST's EEO Policies/Notices
BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.
Tobacco-Free Hiring Statement
To further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire individuals who use tobacco or nicotine products (including but not limited to cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, gum, patch, lozenges and electronic or smokeless cigarettes) in any form in Tennessee and where state law permits. A tobacco or nicotine free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community. All offers of employment will be contingent upon passing a background check which includes an illegal drug and tobacco/nicotine test. An individual whose post offer screening result is positive for illegal drugs or tobacco/nicotine and/or whose background check is verified to be unsatisfactory, will be disqualified from employment, the job offer will be withdrawn, and they may be disqualified from applying for employment for six (6) months from the date of the post offer screening results.
Resources to help individuals discontinue the use of tobacco/nicotine products include smokefree.gov or 1-800-QUIT-NOW.
Healthcare Systems/Data Analyst - Evernorth Health Services - Franklin, TN
Remote or Franklin, TN Job
Evernorth Health Services is hiring an IT Client Liaison to work in the Franklin, TN office; preferred. Requirements * 5 - 7+ years' experience with systems analysis, data analysis and requirements gathering in Healthcare Industry * Thorough understanding of how to interpret customer data and business needs and translate them into technical designs for ETL process
* Experience combing through application code for root cause analysis
* Must be able to read and understand Python and/or Scala code in Azure
* Strong X12 standard working experience within healthcare that includes ANSI 837 Claims (Institutional, Dental, Professional), 835 (Claim Payment/Remittance), 834 (Benefit Enrolment), 276 & 277 (Claim Status), 270 & 271 (Patient Eligibility), 278, 999, TA1
* Possess a solid knowledge of a query language, and understand software design principles
* Solid understanding of data modeling design, data quality principles, source file data extraction, complex data transformation and load processes
* Strong SQL stored procedure review (SQL Server) experience
* Must have capability and desire to mentor others as well as willing to learn from other mentors
* Experience receiving client calls and troubleshooting IT issues or questions
* Experience with member and provider data (large date set)
* Ability to successfully engage in multiple initiatives simultaneously is required
* Ability to interact professionally with a diverse group of peers, managers, executives, and subject matter experts
* Knowledge of all phases of software development including requirements analysis, design, coding, testing, debugging, implementation and support
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
About Evernorth Health Services
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
Manager, Community Relations and Sponsorships
Remote Job
Job Responsibilities:
Manages, develops, and implements signature cause projects and partnerships in accordance with guidelines.
Reviews grant and sponsorship requests for relevance to the mission and priorities.
Prepares and presents Board and Review Committee materials; responds to Board and Review Committee inquires.
Facilitates and convenes relevant parties, builds relationships and new institutional arrangements around community issues.
Initiates ideas, provide policy and procedural information (i.e. internal staff, government/municipalities, non-profit/community organizations).
Provide direct oversight of staff, including performance management, hiring, assignment of duties, and training / development.
Job Qualifications
Education
Bachelor's degree or equivalent work experience required. Equivalent experience is defined as 4 years of professional work experience.
Experience
5 years - Project and/or program management experience required.
2 years - Management and/or leadership experience required
Skills/Certifications
Demonstrated ability to effectively work with senior leadership teams
Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.
Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
Must be a team player, be organized and have the ability to handle multiple projects
Excellent oral and written communication skills
Strong interpersonal and organizational skills
Employees who are required to operate either a BCBST-owned vehicle or a personal or rental vehicle for company business on a routine basis* will be automatically enrolled into the BCBST Driver Safety Program. The employee will also be required to adhere to the guidelines set forth through the program. This includes, maintaining a valid driver's license, auto insurance compliance with minimum liability requirements; as defined in the “Use of Non BCBST-Owned Vehicle” Policy (for employees driving personal or rental vehicles only); and maintaining an acceptable motor vehicle record (MVR).
*The definition for "routine basis" is defined as daily, weekly or at regularly schedule times.
Number of Openings Available:
1
Worker Type:
Employee
Company:
BCBST BlueCross BlueShield of Tennessee, Inc.
Applying for this job indicates your acknowledgement and understanding of the following statements:
BCBST is an Equal Opportunity employer (EEO), and all employees and applicants will be entitled to equal employment opportunities when employment decisions are made. BCBST will take affirmative action to recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.
Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:
BCBST's EEO Policies/Notices
BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.
Tobacco-Free Hiring Statement
To further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire individuals who use tobacco or nicotine products (including but not limited to cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, gum, patch, lozenges and electronic or smokeless cigarettes) in any form in Tennessee and where state law permits. A tobacco or nicotine free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community. All offers of employment will be contingent upon passing a background check which includes an illegal drug and tobacco/nicotine test. An individual whose post offer screening result is positive for illegal drugs or tobacco/nicotine and/or whose background check is verified to be unsatisfactory, will be disqualified from employment, the job offer will be withdrawn, and they may be disqualified from applying for employment for six (6) months from the date of the post offer screening results.
Resources to help individuals discontinue the use of tobacco/nicotine products include smokefree.gov or 1-800-QUIT-NOW.
IT Project Coordinator Intern
Remote Job
At Blue Cross NC, we are committed to making healthcare better for everyone. Our internship program is a cornerstone of our company culture, bringing in fresh perspectives and early-career talent to shape the future of healthcare. During your time with us, you'll contribute to meaningful projects and initiatives, work alongside innovative leaders, and make a real impact on our communities. Our hybrid-flex work environment allows you to thrive from home while also connecting in person with your cohort at our Durham campus during key events.
IT is different here. Our work as project managers pushes the boundaries of what's possible in health care. You will build solutions that make a real difference in people's lives. Driven by the importance of their work, our team members innovate to elevate. We're encouraged to be curious, collaborate, and turn ideas into solutions that transform health care.
**About Our Internship**
We're big picture people who excel at the details. Our Portfolio Delivery Management team keeps our enterprise initiatives on time and on budget. We are the experts when problems come up and use negotiation, creativity, project management and collaboration with stakeholders to find answers. The Project Coordinator Intern will organize and maintain the IT Spoke SharePoint, create project schedules, and learn various tracking tools like Planview. You will also refresh the IT intern onboarding playbook through interactive, engaging visceral multimedia content inclusive to creating a video highlighting your summer experience.
**Desired Skills**
+ Creative problem-solver passionate about analytics
+ Strong interpersonal skills - able to engage with and collaborate with others through effective communication and organization
+ Resourceful, goal-oriented, forward thinking and a willingness to learn, adjust and adapt
+ Familiarity with or interest in computer science, information technology or management information systems
+ Experience with Microsoft Office Suite: Excel, Word, PowerPoint
**The Must-Haves**
+ You will be a rising Junior or rising Senior at an accredited university or college in May 20245
+ You have a passion for IT and an aptitude to learn and use technology to tackle business problems.
+ You're willing and able to work 40 hours per week for : May 19 - July 25 (10 weeks)
+ You will be located in North Carolina or attend a school in North Carolina.
+ You're legally authorized to work in the United States and should not require sponsorship for employment visa status now and in the future.
**What You Offer as a Stand-Out Candidate**
+ You think outside the box and love getting into the details to recommend actionable solutions.
+ You're curious, eager to learn, and open to coaching to help you grow professionally.
+ You bring positive energy, enjoy collaborating with others, hearing other perspectives, and sharing your own creative ideas.
+ You're energized by our mission to improve the health and well-being of our communities.
**Compensation:**
Undergraduates: Rising Sophomore: $18/hr
Undergraduates: Rising Junior/Senior: $21/hr
Returning Interns: $23/hr
Masters Students/JD: $27/hr
MBA Students/PharmD: $36/hr
**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._
$41,600.00 - $46,600.00
**About Us**
It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We're committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians.
Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all.
Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.
**Authorization to Work in the United States**
We use E-verify to confirm authorization to work in the United States. To learn more about E-Verify, including your rights and responsibilities, please visit E-Verify Overview (***************************************************** for English or Visión General de E-Verify (***************************************************************** for Español.
**Request Accommodations**
Blue Cross NC provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please notify HR at ********************** .
**For most roles, you can choose where to work - fully remote in one of the states listed below, in the office, or a hybrid of the two:**
Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming
Insurance Sales Advisor Job
Remote or Denver, CO Job
Title Insurance Sales Advisor About the Organization Description Insurance Sales Advisor Hiring in the following states for remote work ONLY: AZ, CO, CA, NV, FL, GA, IL, MI, TX Who is Covered? At Covered, we are focused on making insurance easy to understand and painless to purchase. We combine intuitive technology with a human touch to help consumers quote, compare, and purchase multiple insurance products in minutes. By partnering with lenders, financial institutions, and fintech companies, we deliver our personalized embedded insurance marketplace to their customers. If you are looking for career opportunities within a growing company built by a compassionate and solutions-oriented team, you have come to the right place.
Position Summary
Our Insurance Sales Advisors actively execute our mission and vision by meeting our customers where and when they need insurance. They provide a seamless and enjoyable experience to our customers by producing quotes, making recommendations, and guiding them through the insurance purchasing process from start to finish. This is a sales-oriented role that plays a very important role in driving the growth of the organization. This position reports to the Insurance Sales Manager and collaborates regularly with other advisors and teammates across the organization.
Position Responsibilities:
* Write personal lines policies for clients utilizing referrals from partners and direct applications and interfacing directly with clients while meeting production objectives.
* Utilize internal and external systems to produce insurance quotes from property and casualty carriers that will meet the client's needs.
* Perform needs analysis with the client, utilizing a consultative approach, and making recommendations that are suitable for the customer.
* Address customer inquiries regarding their current policy and/or assist them in finding the appropriate policy to meet their personal needs.
* Present complex information to customers in a manner that is easy to understand and empathetic to their needs.
* Participate in educational opportunities keeping product knowledge current and up-to-date.
* Collaborate with fellow cohorts and participate in team activities as needed to foster a culture of continuous improvement, positivity, and teamwork.
Position Requirements
Experience and Education:
Active Property & Casualty license is required
Minimum 2 years of experience as a Property & Casualty insurance agent is preferred
Strong knowledge of various company auto and homeowner products
Demonstrated skills in problem-solving and analysis
Ability to manage time effectively
Excellent written and verbal communication skills.
Strong working knowledge of computers and other office productivity tools, with an aptitude to learn new software and systems.
Generous with time spent building relationships with team members, partners, and customers.
Ability to work independently and as a collaborative member of a team.
An appreciation for a transparent, open, and honest working environment.
Must value accountability and dedication to producing an excellent end result.
Values the importance of representing and protecting the company's cultural DNA.
Benefits
This position includes a competitive benefits package to include an extraordinary culture, medical, dental, vision, STD, LTD, 401(k), time off, and paid holidays.
Travel Requirements: Less than 10%
Salary Range: $40,000 - $50,000 + bonus opportunity
This is intended to provide information essential to understanding the scope of this position and the general nature and level of work performed by job holders within this position. This job description is not intended to be an exhaustive list of qualifications, skills, efforts, duties, responsibilities, or working conditions associated with the position.
We are an equal opportunity employer and we do not discriminate on the basis of any protected attribute, protected under applicable law. We make reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as any mental health or physical disability needs.
Essential Job Functions
(Must be able to be performed with or without reasonable accommodation):
* Work Environment: This position is primarily based in an office environment.
* Physical Demands:
* Must be able to sit for extended periods of time
* Possess visual acuity in order to see a computer
* Must possess manual dexterity in order to produce quotes on a computer and other information needed by clients
* Must be able to speak with clients, partners, and internal staff
* Must be able to hear clients, partners, and internal staff
* Work Schedule: Full-time. The position may require employees to work various shifts as necessary to support company objectives
* Occasional travel (less than 25%) might be required
* Work Location: Covered's headquarters is in Denver, CO. Position is eligible for remote work upon the employee meeting certain criteria.
Close Date Post Internal Days 365 EOE Statement We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law. Req Number OPE-23-00003
This position is currently accepting applications.
Apply Now
Alteryx Engineer Advisor - Evernorth Health Services
Remote or Bloomfield, CT Job
Join our dynamic team and play a pivotal role in shaping the future of Business Intelligence (BI) (Infrastructure Engineering Advisor)! You will provide innovative engineering support and oversight for the design and development of cutting-edge BI solutions in the realm of information technology. Take charge of exciting, complex projects that span multiple sites and domains, ensuring seamless integration of powerful BI tools.
Be the hero who tackles challenging BI infrastructure compatibility issues, leveraging your expertise to blend system architecture with project goals and customer needs flawlessly. Collaborate with a passionate team of IT professionals, crafting strategies that will drive our BI engineering efforts to new heights. Together, we will transform data into actionable insights and empower our organization to make informed decisions like never before!
**Responsibilities:**
BI Application Suite Architecture and Management
+ Gather theater-wide customer requirements, design, and implement system architectures to ensure high availability and low application latency for various BI suite services.
+ Configure and deploy the complete suite of BI applications to align with customer requirements.
+ Collaborate with a team of developers to integrate BI services into web applications tailored to specific business processes.
+ Manage content by creating maps, overlays, and auditing reports as needed.
+ Oversee web infrastructure, including IIS, DNS, HTTPS, domain certificates, and Identity with Active Directory/LDAP.
+ Automate routine tasks using appropriate technologies to manage the BI server environment, demonstrating improved efficiencies and cost savings.
+ Work with DevOps to deploy new applications, services, and scheduled jobs, while supporting automation capabilities and requirements.
+ Participate in risk assessments and the project life cycle design activities to assist more senior engineers.
+ Assist in the planning and implementation of system upgrades and maintenance processes.
+ Ensure service availability in accordance with customer-established requirements.
+ Complete day-to-day Infrastructure Engineering tasks independently.
+ Serve as the escalation point for technical support and troubleshooting efforts.
+ Provide periodic off-hours and on-call support in a 24/7/365 environment.
+ Perform other engineering duties as assigned.
Business Acumen
+ Exhibit strong support and customer service skills with a 'meet people where they are' approach.
+ Show inquisitiveness and a desire to continually learn and enhance the customer experience.
+ Participate in user meetings for education and networking opportunities.
Written and Verbal Communication
+ Clearly articulate designs, issues, and recommendations in a succinct and accurate manner.
+ Be comfortable providing technical briefings to decision-makers.
+ Effectively communicate technical and non-technical information to both technical staff and business owners.
**Qualifications:**
+ High School Diploma or equivalent with a least five years of experience in all phases of BI infrastructure and administration. support, or equivalent in education and work experience years.
+ Bachelor's degree in computer science or a related field is required, along with at 3 or more years of experience in all phases of BI infrastructure and administration. support, or equivalent in education and work experience.
+ 2 or more years of experience in product development.
+ SAS/Posit/OAS engineering and AWS experience are required
+ Familiarity with various BI product suites, including BI Servers, Web Portals, Data Stores, and Desktop Clients.
+ BI Infrastructure Support - Installs, Upgrades, Patches, etc
+ BI Architecture Experience
+ Level 3 BI Toolset Support
+ Requirements Gathering
+ Windows Server support experience
+ Shell Scripting/Automation experience
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
For this position, we anticipate offering an annual salary of 103,400 - 172,400 USD / yearly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group .
**About The Cigna Group**
Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we're dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.
_Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws._
_If you require reasonable accommodation in completing the online application process, please email:_ _*********************_ _for support. Do not email_ _*********************_ _for an update on your application or to provide your resume as you will not receive a response._
_The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State._
_Qualified applicants with criminal histories will be considered for employment in a manner_ _consistent with all federal, state and local ordinances._