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Senior Consultant jobs at HCSC - 72 jobs

  • Medicare Senior Business Consultant - Hybrid

    HCSC 4.5company rating

    Senior consultant job at HCSC

    At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. Job Summary The Medicare Senior Business Consultant is responsible for providing internal consulting services, business analysis and provides direction to ensure alignment and integration across functional areas in support of organizational goals. This position ensures consistency and efficiency requiring leadership of major, complex, and strategic cross-divisional and enterprise-wide projects from inception to completion. This includes oversight coordination, and ability to implement projects according to dynamic and critical timelines. This also includes oversight of project teams, resources, and budget, and interacting with all levels of management including senior management. This position supports the prioritization of Medicare activities and tracks progress to goals. Required Job Qualifications: * Bachelor's degree and 5 years of experience OR 9 years of experience in business analysis, process improvement, project management, business operations or relevant health care industry experience. * 3 years of experience leading with large and complex multi-million dollar projects. * Experience communicating with senior management from multiple divisions. * Experience developing and delivering presentations. * Problem resolution experience and skills. * Knowledge of strategic planning techniques and industry trends * Experience interpreting business and financial information * Negotiations skills. * Verbal and written communications skills including establishing working relationships across departments, preparing presentations to senior management, and establishing team environment. * Organizational skills. * Experience managing multiple complex projects successfully. * Detail oriented. * PC proficiency to include Microsoft Office products Preferred Required Job Qualifications: * Health insurance or healthcare industry experience strongly with an emphasis on Medicare Operations is strongly preferred. * Proven analytical thinking and the ability to move from strategy to action. * Prior internal or external consulting experience preferred. * Understanding of Software Development Life Cycle (SDLC) in the project management process preferred. * Schedule: This is a Flex (Hybrid) role: 3 days in office; 2 days remote. * Location: Richardson, TX or Chicago, IL. * Sponsorship: Sponsorship is not available. #LI-Hybrid #LI-JR2 Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process! Pay Transparency Statement: At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting ************************************** The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan. HCSC Employment Statement: We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. Base Pay Range $61,500.00 - $136,100.00 Exact compensation may vary based on skills, experience, and location.
    $61.5k-136.1k yearly Auto-Apply 23d ago
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  • Sr Business Solutions Consultant

    HCSC 4.5company rating

    Senior consultant job at HCSC

    At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. Job Summary This position is responsible for leading business analysis, ensuring alignment and integration across functional areas in support of divisional strategies, and ensuring consistency and efficiency of major, complex, and strategic cross-divisional and enterprise-wide projects and initiatives from inception to completion. Provides oversight & coordination of project teams, resources, and budget to implement projects or initiatives according to dynamic and critical timelines. Interacts with all levels of management including senior management. Supports the prioritization of transformational program activities and tracks progress to goals. Support writing and executing test cases based on business requirement hands on experience with SQL excel and test management NOTE: This hybrid role can be located in CHICAGO IL, NASHVILLE, TN or RICHARDSON TX ~ relocation will not be offered; sponsorship is not available. Required Job Qualifications: * Bachelor's degree and 5 years of experience OR 9 years of experience in business testing, business analysis, process improvement, project management, business operations or relevant health care industry experience * 3 years of experience leading with large and complex multi-million-dollar projects. * Experience communicating with senior management from multiple divisions. * Experience developing and delivering presentations. * Problem resolution experience and skills. * Knowledge of strategic planning techniques and industry trends * Experience interpreting business and financial information * Negotiations skills. * Verbal and written communications skills including establishing working relationships across departments, preparing presentations to senior management, and establishing team environment. * Organizational skills. * Experience managing multiple complex projects successfully. * Detail oriented. * PC proficiency to include MS Office products * Knowledge and/or experience with: * · Medicare Part A/B/D * · Provider workflows & Provider application - Symplr * · EDI formats - 837 I&P, 276/277, 270/271, 278, 834 * · Member Enrollment - Elements application * · Member Collaterals * · Provider Credentialing - sCRED application * · Claims Intake process * · Claims Adjudication logic - FACETS application * · EOB * · Provider Payments - 835 remittance files & EOP * · CMS reporting * · SalesForce * · Evolve/Broker * Test case management tools such as Zephyr * Agile tool such as Jira/Rally * SQL * Health insurance or healthcare industry experience with emphasis on Product/Sales knowledge Preferred Required Job Qualifications: * Proven strategic thinking and execution * Ability to drive decisions, create optionality and determine impacts of options #LI-BS1 #LI-Hybrid #INCR Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process! Pay Transparency Statement: At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting ************************************** The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan. HCSC Employment Statement: We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. Base Pay Range $82,700.00 - $149,300.00 Exact compensation may vary based on skills, experience, and location.
    $82.7k-149.3k yearly Auto-Apply 37d ago
  • Principal Network Management Consultant

    Health Care Service Corporation 4.1company rating

    Chicago, IL jobs

    Principal Network Mgmt Cons page is loaded## Principal Network Mgmt Conslocations: IL - Chicagotime type: Full timeposted on: Posted Yesterdayjob requisition id: R0047015At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.Join HCSC and be part of a purpose-driven company that will invest in your professional development.# # **Job Summary**### This position is responsible for provider recruitment and contracting of Physicians, Physician Groups both large and small (IPA's, PHO's, large independent hospital systems, Integrated & non-Integrated systems, Value Based Contracting, Etc). Develop and negotiate contracts. Develop and maintain relationships with assigned providers. Ensure strategic coverage for all LOBs and maintain required adequacy for each LOB. The person in this position it is expected to be a SME in the department for multiple assigned areas.### **Job Requirements:*** Bachelor's degree and 4 years provider contracting experience OR Master's degree and 3 years contracting experience OR 8 years business experience including 4 years provider contracting experience. Contracting experience involves negotiating reimbursements, financial arrangements and rates.* Extensive knowledge of provider and facility contracting, products, and claims/processing systems.* Negotiation skills.* Relationship building skills.* Knowledge of marketplace.* Meet deadlines and work well under pressure.* Verbal and written communication skills to interact with all levels of corporate personnel and providers.* PC proficiency to include Microsoft Office.* Analytical skills and business acumen to analyze financial data to determine financial impact of negotiations.* Ability and willingness to travel within assigned areas of responsibility, including overnight stays.**This is a Flex (Hybrid) role: 3 days in office; 2 days remote.**#LI-MW2 #LI-Hybrid### ### **Pay Transparency Statement:**At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting .The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.## HCSC Employment Statement:We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.# # **Base Pay Range**$90,900.00 - $164,200.00Exact compensation may vary based on skills, experience, and location.locations: IL - Chicagoposted on: Posted 13 Days AgoFor more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities.Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren't afraid to make innovative contributions. We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity you'll have to improve health care delivery in an open, collaborative environment. #J-18808-Ljbffr
    $90.9k-164.2k yearly 5d ago
  • Remote Finance Special Projects Lead

    Humana Inc. 4.8company rating

    Washington, DC jobs

    A leading health services organization is seeking a Lead - Finance Special Projects to drive process improvements within the Finance function. This position requires collaboration with Finance leadership to optimize operations and promote technology adoption. Candidates should have a Bachelor's degree in Finance or related field and extensive experience in benchmarking and project management. This role involves creating project plans and tracking progress to ensure successful project delivery. Various benefits and a compensation range of $94,900 - $130,500 annual are offered. #J-18808-Ljbffr
    $94.9k-130.5k yearly 2d ago
  • Remote Finance Special Projects Lead

    Humana Inc. 4.8company rating

    Urban Honolulu, HI jobs

    A healthcare organization is seeking a Lead - Finance Special Projects in Honolulu, Hawaii to drive process improvements within Finance. The ideal candidate will have a Bachelor's degree, extensive experience in benchmarking, and strong analytical skills. This role involves collaboration with Finance leadership to implement solutions optimizing operations. Occasional travel is required. The compensation range is $94,900 - $130,500 annually, with additional bonuses and comprehensive benefits. #J-18808-Ljbffr
    $94.9k-130.5k yearly 5d ago
  • Senior Infra Ops Lead: Cloud & GenAI Enablement (Remote)

    Humana Inc. 4.8company rating

    Boston, MA jobs

    A leading healthcare company is seeking an experienced Infrastructure Operations leader to drive innovation in AI and cloud technologies. The ideal candidate will have over 10 years in infrastructure, with a strong background in AI/ML, leading cloud operations for Azure and AWS. Key responsibilities include overseeing cloud strategy and governance, enhancing operational performance, and fostering partnerships across teams. This role offers a competitive salary and benefits focused on well-being. #J-18808-Ljbffr
    $114k-139k yearly est. 3d ago
  • Healthcare Economics Consultant - Remote

    Unitedhealth Group 4.6company rating

    Minnetonka, MN jobs

    At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. Primary Responsibilities: Support internal clinical, financial and quality data analysis to support value-based care agreements with various provider types at a national and local level Create and support standard financial, utilization and quality reporting in accordance with contracting guidelines Support ad-hoc analysis through gathering claims, financial, or membership data and summarizing key findings clearly with limited guidance Support internal data analysis and other deliverables through data troubleshooting and data validation with guidance Understand conceptual strategies and be able to present key deliverables, answer questions, participate in discussions, and make recommendations via meetings and emails Lead projects to completion by contributing to the analysis and creation of financial reporting or the automation of reporting Proactively manage routine processes and anticipating customer needs through independent prioritization Serve as a resource to executive leadership in support of value based contracting strategy Solve complex and ambiguous problems with broad impact on the business through critical thinking and resourcefulness You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: 3+ years of experience in an analytics capacity with evidence of proactive critical thinking and creative problem solving Experience in the healthcare insurance industry with exposure to medical claims data Intermediate or higher level of proficiency in MS Excel and Pivot Tables Beginner or higher level of proficiency with coding in Snowflake, Toad, Snowsight, SQL, or SAS Demonstrated highly effective verbal and written communication skills for a variety of audiences Demonstrated ability to effectively manage multiple priorities Preferred Qualification: Demonstrated familiarity with SMART or other claims platform *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 to $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
    $72.8k-130k yearly 2d ago
  • Sr Software Engineer- Remote

    Unitedhealth Group 4.6company rating

    Austin, TX jobs

    Optum Tech is a global leader in health care innovation. Our teams develop cutting-edge solutions that help people live healthier lives and help make the health system work better for everyone. From advanced data analytics and AI to cybersecurity, we use innovative approaches to solve some of health care's most complex challenges. Your contributions here have the potential to change lives. Ready to build the next breakthrough? Join us to start Caring. Connecting. Growing together. Hiring a Senior Software Engineer who has a passion for learning, is a strong problem solver, and a critical thinker with broad technical experience. We need someone who has background and experience with both legacy and new product development and DevOps delivery. This role is for an individual contributor on an Agile team requiring hands-on technical skill and problem-solving for a large, complex Microsoft .NET full stack application development project. Core application capabilities are focused on E2E Identity and Access Management (IAM). You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: The role includes, but is not limited to planning, analysis, design, development, testing, review, debugging, tools analysis, documentation, research and development, implementation, and maintenance Delivery requires automated test (manual testing as needed) mindfulness Engineering focus on enriching the Customer Experience through high quality functional delivery, efficiency, testability, reliability, scalability, availability, and security of applications Foster high performance, collaborative technical work Support mentoring of new and existing team members Present and demonstrate work to technical and non-technical stakeholders You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: Undergraduate degree or equivalent experience 7+ years of experience with C# and .NET Software Development Life Cycle (SDLC) 4+ years of experience with RESTful Web API Development 4+ years of experience using SQL, Microsoft SQL Server, & SQL profiling / performance tuning 2+ years of experience with Entity Framework or equivalent experience with other data access technologies 2+ years of experience with Front end development (React / Blazer Web Assembly preferred) Expertise in Agile and DevOps methodologies Demonstrated skills in active listening with the ability to express oneself clearly and effectively Demonstrated skills and experience in collaborating, influencing, problem solving and negotiating Preferred Qualifications: Git Source Code Management, Test Automation, Azure DevOps Application Lifecycle Management (ALM) Experience with Azure Cloud Engineering, CI/CD, Microservice background, and Infrastructure as Code (IaC) Tools (e.g. Terraform) Fosters accountability, transparent communication, innovation and leading by example Identity and Access Management experience Directory Services Development, Authentication and Provisioning experience Requirements and technical specification documentation experience Proficiency in MS Office (Word, Excel, Outlook, PowerPoint, Access, MS Visio) Solid organizational skills and focus on accuracy and attention to detail *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 to $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
    $91.7k-163.7k yearly 6d ago
  • Medicare Senior Business Consultant - Hybrid

    Health Care Service Corporation 4.1company rating

    Chicago, IL jobs

    At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. **Job Summary** The Medicare Senior Business Consultant is responsible for providing internal consulting services, business analysis and provides direction to ensure alignment and integration across functional areas in support of organizational goals. This position ensures consistency and efficiency requiring leadership of major, complex, and strategic cross-divisional and enterprise-wide projects from inception to completion. This includes oversight coordination, and ability to implement projects according to dynamic and critical timelines. This also includes oversight of project teams, resources, and budget, and interacting with all levels of management including senior management. This position supports the prioritization of Medicare activities and tracks progress to goals. **Required Job Qualifications:** + Bachelor's degree and 5 years of experience OR 9 years of experience in business analysis, process improvement, project management, business operations or relevant health care industry experience. + 3 years of experience leading with large and complex multi-million dollar projects. + Experience communicating with senior management from multiple divisions. + Experience developing and delivering presentations. + Problem resolution experience and skills. + Knowledge of strategic planning techniques and industry trends + Experience interpreting business and financial information + Negotiations skills. + Verbal and written communications skills including establishing working relationships across departments, preparing presentations to senior management, and establishing team environment. + Organizational skills. + Experience managing multiple complex projects successfully. + Detail oriented. + PC proficiency to include Microsoft Office products **Preferred Required Job Qualifications:** + Health insurance or healthcare industry experience strongly with an emphasis on Medicare Operations is strongly preferred. + Proven analytical thinking and the ability to move from strategy to action. + Prior internal or external consulting experience preferred. + Understanding of Software Development Life Cycle (SDLC) in the project management process preferred. + **Schedule:** This is a Flex (Hybrid) role: 3 days in office; 2 days remote. + **Location:** Richardson, TX or Chicago, IL. + Sponsorship: Sponsorship is not available. \#LI-Hybrid \#LI-JR2 **Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!** **Pay Transparency Statement:** At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting ************************************* . The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan. **HCSC Employment Statement:** We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. **Base Pay Range** $61,500.00 - $136,100.00 Exact compensation may vary based on skills, experience, and location. **Join our talent community and receive the latest HCSC news, content, and be first in line for new job opportunities.** **Join our Talent Community. (******************************************** PA8v\_eHgqFiDb2AuRTqQ)** For more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities. Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren't afraid to make innovative contributions. We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity you'll have to improve health care delivery in an open, collaborative environment. HCSC is committed to diversity in the workplace and to providing equal opportunity to employees and applicants. If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at ************** to request reasonable accommodations. Please note that only **requests for accommodations in the application process** will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "candidate home" to view your job submissions. Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma, and Blue Cross and Blue Shield of Texas, Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, and Independent Licensee of the Blue Cross and Blue Shield Association © Copyright 2025 Health Care Service Corporation. All Rights Reserved.
    $61.5k-136.1k yearly 60d+ ago
  • Sr. AI Architect (Cloud Based)

    Florida Blue 4.5company rating

    Remote

    We're looking for an AI Cloud Architect to lead our journey from on-premise data centers to AWS and/or Azure and to design cloud-native AI and data platforms. You'll define the target architecture for AI/ML, LLMs, and agent-based solutions, and ensure we integrate securely and reliably with vended platforms like Kore.ai, Salesforce, Microsoft SharePoint, Windsurf, and our core enterprise systems via Cloud. What You Will Be Doing You will be the architectural lead ensuring our move from on-premise to cloud unlocks modern AI capabilities, MCP, agents, and A2A integrations while keeping our data, systems, and customers safe. Your work will directly shape how AI is delivered and scaled across the organization. Design and execute a cloud-first AI architecture strategy on AWS/Azure, leading the migration of AI and analytics workloads from on-prem to cloud in line with business goals. Own the end-to-end solution architecture for AI/ML, LLM, and agent-based projects (MCP, agents, A2A) from concept through deployment and operations. Evaluate, recommend, and govern AI/ML platforms and technologies, defining reference architectures, patterns, and standards for integrations with Kore.ai, Salesforce, SharePoint, Windsurf, and internal systems. Collaborate with Data Science, Engineering, Security, and Product teams to design and deliver innovative, scalable AI solutions and cloud-native data/ML pipelines. Implement and enforce security, compliance, and responsible AI practices (IAM, encryption, auditability, observability) for AI workloads and agent interactions. Engage and influence stakeholders across the organization, promoting the AI architectural vision, providing guidance on architectural decisions, and mentoring teams to build cloud-native AI capabilities. Foster a culture of continuous learning and innovation, staying current on emerging trends in AI/ML, LLMs, agents, and cloud services, and feeding them into the roadmap for ongoing improvement. What We Require 6+ years related work experience as Solutions Architect working on progressively complex IT projects spanning across domains, including multiple AI-related technologies. Related Bachelor's degree or additional related equivalent work experience Establish design principles, architecture standards and best practices in alignment with IT strategy, with an emphasis in AI-related technologies. Continuous improvement on technical and business skills Monitors and anticipates technology trends and investigates against organizational objectives and needs. Prepares benchmarking reports and presentations Ability to contribute and evolve IT Strategies in alignment with advancement in technologies Conduct technical design and architect reviews Execute peer reviews and undertakes active knowledge management Express complex concepts clearly and concisely both orally and in writing Provide Technology inputs into business cases Use relevant frameworks and guidelines for various Architecture exercises Working knowledge of modern technology stacks including user interface, services, databases, security, etc. What We Prefer Working knowledge of integrating with big Data platforms Working knowledge on Analytics platforms Working knowledge on enterprise search engines 7+ years in software, data, or cloud architecture, including 3+ years on AWS and/or Azure. Hands-on experience with cloud-native design (containers, Kubernetes, serverless), data platforms, and AI/ML services Proven track record migrating workloads from on-prem to cloud in an enterprise environment. Practical experience with LLM-based systems, AI agents, or orchestration frameworks, and integrating with SaaS/enterprise platforms (e.g., Salesforce, Microsoft 365/SharePoint, Kore.ai, Windsurf or similar). Strong understanding of cloud security, IAM, networking, and compliance. Excellent communication skills and the ability to influence and guide cross-functional teams. General Physical Demands Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally. Physical/Environmental Activities Must be able to travel to multiple locations for work (i.e. travel to attend meetings, events, conferences). Occasionally May be exposed to outdoor weather conditions of cold, heat, wet, and humidity. What We Offer As a Florida Blue employee, you will thrive in our Be Well, Work Well, GuideWell culture where being well as an individual, and working well as a team, are both important in serving our members and communities. To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to: Medical, dental, vision, life and global travel health insurance Income protection benefits: life insurance, short- and long-term disability programs Leave programs to support personal circumstances Retirement Savings Plan including employer match Paid time off, volunteer time off, 10 holidays and 2 well-being days Additional voluntary benefits available; and a comprehensive wellness program Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ. To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases. Targeted Annualized Offer Hiring Range: $138,200 - $172,800 Annualized Salary Range: $138,200 - $224,600 Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring. We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.
    $138.2k-224.6k yearly Auto-Apply 15d ago
  • Client Implementation Consultant

    Health Care Service Corporation 4.1company rating

    Danville, IL jobs

    At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. **Job Summary** This Position Is Responsible For Leading Client Facing Implementation Initiatives And Accountable For National/Key Account Operational Deliverables. Responsible For Leading Multi-Disciplinary Teams Representing Various Internal Operational Areas And For Account Installation Management. In Collaboration With Sales And Account Management, Provides Operational Consultation And Strategic Roadmap Development For Customers. Acts As Subject Matter Expert On Industry Best Practices And Strategic Trends In Product, Legislation And Account Implementation. Responsible For Cultivating And Maintaining Relationships With Key Internal And External Stakeholders. Drive The Identification Of Opportunities For Improving Efficiencies And Processes For The Implementation Operation And Client Experience And Lead Implementation Of Those Solutions. JOB REQUIREMENTS: * Bachelor degree and 5 years of experience in marketing, strategic consulting, project management, product management or account operations. * Enterprise implementation experience or external consulting experience. * Knowledge of health care regulatory and legislative process, health care market and products. * Knowledge of health care marketing, sales and claims adjudication. * Experience as a thought leader and experience leading cross-functional workgroups. * Financial and budget management experience relating to projects or operations. * Issue resolution experience and skills including business operations solutions and conflict management resolutions. * Project management experience including managing multiple projects concurrently. * Experience driving results to meet deadlines. * Analytical skills. * PC proficiency including Word, Excel, PowerPoint. * Clear and concise written and verbal communications skills including presentation and interpersonal skills in order to work across various departments and with various levels of management, handling sensitive or difficult situations and develop and deliver training to internal and external customers. PREFERRED JOB REQUIREMENTS: * Master degree. * Knowledge of state and federal legislature process. **Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!** **Pay Transparency Statement:** At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting ************************************* . The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan. **HCSC Employment Statement:** We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. **Base Pay Range** $92,700.00 - $167,500.00 Exact compensation may vary based on skills, experience, and location. **Join our talent community and receive the latest HCSC news, content, and be first in line for new job opportunities.** **Join our Talent Community. (******************************************** PA8v\_eHgqFiDb2AuRTqQ)** For more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities. Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren't afraid to make innovative contributions. We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity you'll have to improve health care delivery in an open, collaborative environment. HCSC is committed to diversity in the workplace and to providing equal opportunity to employees and applicants. If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at ************** to request reasonable accommodations. Please note that only **requests for accommodations in the application process** will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "candidate home" to view your job submissions. Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma, and Blue Cross and Blue Shield of Texas, Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, and Independent Licensee of the Blue Cross and Blue Shield Association © Copyright 2025 Health Care Service Corporation. All Rights Reserved.
    $92.7k-167.5k yearly 5d ago
  • Principal Marketing Strategy Consultant

    Health Care Service Corporation 4.1company rating

    Chicago, IL jobs

    At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. **Job Summary** The Principal Marketing Strategy Consultant serves as the strategic operator and integrator for the DSVP of Marketing, driving alignment, coordination, and execution of the Marketing organization's highest priorities. This role partners closely with cross-functional marketing leaders and enterprise stakeholders to translate strategy into action, ensuring initiatives are clearly defined, aligned to business objectives, and delivered with rigor. Operating at the center of the Marketing organization, the Principal Consultant enables effective decision-making, accelerates execution, and ensures Marketing functions as a unified, high-performing team in support of enterprise goals. Required Job Qualifications: - Bachelor's degree / Master's Degree / MBA and 7 years of general industry experience or 3 years consulting experience at a top tier consulting firm - Strategy development/planning/implementation: Knowledge of corporate strategy and/or transformation core skill sets; experience formulating, planning, and/or implementing strategy and transformative efforts. - Analysis/synthesis/insight generation: Ability to conduct quantitative and qualitative analysis, provide insights and implications, inform decision making, and make recommendations/prioritize new opportunities to pursue. - Critical thinking/problem solving: Ability to proactively identify and resolve complex problems with some oversight. - Project management: Experience managing complex projects with some oversight. - Collaboration and interpersonal effectiveness: Ability to build strong connections with people and teams, drive results by working across the matrixed environment, and work directly with leadership with some oversight. - Communication skills: Ability to communicate effectively through verbal, written and visual channels. - Ability to work within a very fast-paced, quickly evolving organization and manage multiple, complex priorities. Preferred Job Qualifications: - Advanced degree such as MBA, MHA, MD, JD, or PhD - Experience in the healthcare industry, especially the health insurance sector - Experience with marketing \#LI-CH1 \#LI-Hybrid INJLFW **Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!** **Pay Transparency Statement:** At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting ************************************* . The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan. **HCSC Employment Statement:** We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. **Base Pay Range** $112,200.00 - $202,600.00 Exact compensation may vary based on skills, experience, and location. **Join our talent community and receive the latest HCSC news, content, and be first in line for new job opportunities.** **Join our Talent Community. (******************************************** PA8v\_eHgqFiDb2AuRTqQ)** For more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities. Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren't afraid to make innovative contributions. We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity you'll have to improve health care delivery in an open, collaborative environment. HCSC is committed to diversity in the workplace and to providing equal opportunity to employees and applicants. If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at ************** to request reasonable accommodations. Please note that only **requests for accommodations in the application process** will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "candidate home" to view your job submissions. Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma, and Blue Cross and Blue Shield of Texas, Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, and Independent Licensee of the Blue Cross and Blue Shield Association © Copyright 2025 Health Care Service Corporation. All Rights Reserved.
    $112.2k-202.6k yearly 1d ago
  • Principal Cloud AI Architect

    Healthcare Services 4.1company rating

    Remote

    Thank you for your interest in joining Solventum. Solventum is a new healthcare company with a long legacy of solving big challenges that improve lives and help healthcare professionals perform at their best. At Solventum, people are at the heart of every innovation we pursue. Guided by empathy, insight, and clinical intelligence, we collaborate with the best minds in healthcare to address our customers' toughest challenges. While we continue updating the Solventum Careers Page and applicant materials, some documents may still reflect legacy branding. Please note that all listed roles are Solventum positions, and our Privacy Policy: *************************************************************************************** applies to any personal information you submit. As it was with 3M, at Solventum all qualified applicants will receive consideration for employment without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. Job Description: Principal Cloud AI Architect 3M Health Care is now Solventum At Solventum, we enable better, smarter, safer healthcare to improve lives. As a new company with a long legacy of creating breakthrough solutions for our customers' toughest challenges, we pioneer game-changing innovations at the intersection of health, material and data science that change patients' lives for the better while enabling healthcare professionals to perform at their best. Because people, and their wellbeing, are at the heart of every scientific advancement we pursue. We partner closely with the brightest minds in healthcare to ensure that every solution we create melds the latest technology with compassion and empathy. Because at Solventum, we never stop solving for you. The Impact You'll Make in this Role As a Principal Cloud AI Architect, you will have the opportunity to tap into your curiosity and collaborate with some of the most innovative and diverse people around the world. Here, you will make an impact by: Leading the architecture and strategy for Solventum's enterprise-scale AI/ML platforms on AWS, including Amazon SageMaker, Amazon Bedrock, Amazon HealthLake, and associated cloud-native services. Implementing secure, scalable, and compliant AI solutions that support clinical insights, operational intelligence, and generative AI use cases across Solventum's healthcare product ecosystem. Determining cloud, data, and model governance patterns that ensure responsible AI, auditability, observability, model monitoring, and regulatory alignment (HIPAA, HITRUST, PHI/PII protections). Supporting product leaders, data scientists, and engineering teams by providing deep technical guidance on cloud architecture, ML Ops, integration patterns, and platform modernization efforts. To set you up for success in this role from day one, Solventum requires (at a minimum) the following qualifications: • Bachelor's Degree or higher AND 10 years of job-related experience OR • High School Diploma/GED AND 14 years of job-related experience AND In addition to the above requirements, the following are also required: • 8 years of experience architecting or engineering cloud-native AI/ML systems • 5 years of hands-on experience with AWS services (e.g., SageMaker, Bedrock, EC2, EKS, S3, Redshift, Lambda) • 5 years of experience designing or supporting ML Ops pipelines, including model deployment, monitoring, and lifecycle governance • 3 years of experience working in regulated or data-sensitive environments (healthcare, life sciences, government, or similar) • Ability to travel as needed for business purposes Additional qualifications that could help you succeed even further in this role include: • Master's degree in Computer Science, Data Science, Engineering, or related disciplines from an accredited institution • Five (5) years of experience designing AI/ML solutions for healthcare, clinical analytics, or medical data environments • Skills include: strategic communication, executive-level storytelling, cross-functional collaboration, influencing without authority, and the ability to translate complex AI architectures into business value Work Location Remote - US Travel May include up to 10% domestic travel Relocation Assistance Is not authorized Must be legally authorized to work in country of employment without sponsorship for employment visa status (e.g., H1B status). Supporting Your Well-being Solventum offers many programs to help you live your best life - both physically and financially. To ensure competitive pay and benefits, Solventum regularly benchmarks with other companies that are comparable in size and scope. Onboarding Requirement: To improve the onboarding experience, you will have an opportunity to meet with your manager and other new employees as part of the Solventum new employee orientation. As a result, new employees hired for this position will be required to travel to a designated company location for on-site onboarding during their initial days of employment. Travel arrangements and related expenses will be coordinated and paid for by the company in accordance with its travel policy. Applies to new hires with a start date of October 1st 2025 or later.Applicable to US Applicants Only:The expected compensation range for this position is $195,925 - $253,550, which includes base pay plus variable incentive pay, if eligible. This range represents a good faith estimate for this position. The specific compensation offered to a candidate may vary based on factors including, but not limited to, the candidate's relevant knowledge, training, skills, work location, and/or experience. In addition, this position may be eligible for a range of benefits (e.g., Medical, Dental & Vision, Health Savings Accounts, Health Care & Dependent Care Flexible Spending Accounts, Disability Benefits, Life Insurance, Voluntary Benefits, Paid Absences and Retirement Benefits, etc.). Additional information is available at: *************************************************************************************** of this position include that corporate policies, procedures and security standards are complied with while performing assigned duties. Solventum is committed to maintaining the highest standards of integrity and professionalism in our recruitment process. Applicants must remain alert to fraudulent job postings and recruitment schemes that falsely claim to represent Solventum and seek to exploit job seekers. Please note that all email communications from Solventum regarding job opportunities with the company will be from an email with a domain *****************. Be wary of unsolicited emails or messages regarding Solventum job opportunities from emails with other email domains. Please note, Solventum does not expect candidates in this position to perform work in the unincorporated areas of Los Angeles County.Solventum is an equal opportunity employer. Solventum will not discriminate against any applicant for employment on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, or veteran status. Please note: your application may not be considered if you do not provide your education and work history, either by: 1) uploading a resume, or 2) entering the information into the application fields directly. Solventum Global Terms of Use and Privacy Statement Carefully read these Terms of Use before using this website. Your access to and use of this website and application for a job at Solventum are conditioned on your acceptance and compliance with these terms. Please access the linked document by clicking here, select the country where you are applying for employment, and review. Before submitting your application you will be asked to confirm your agreement with the terms.
    $195.9k-253.6k yearly Auto-Apply 11d ago
  • Prin Div Strategy Consultant

    Health Care Service Corporation 4.1company rating

    Chicago, IL jobs

    At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. **Job Summary** This position is responsible for assisting with leading cross-functional VBC Contract operations team responsible for contract modeling/simulations, program and contract level assessments, operational readiness activities all in alignment with network contracting, driving business validation. Assisting the leadership team with driving VBC business priorities, Executive Operational reporting, and operational excellence across all the markets. Collaborating with several cross-functional teams, strategies, network contracting, provider operations and actuarial analytics needs for the division and working with divisional leadership on future state strategies and business plans for functional areas. Working with enterprise areas to ensure there is alignment with the divisional strategy and operational imperatives. **Required Job Qualifications:** + Bachelor degree and 6 years experience in health care, health insurance, or strategic consulting environment OR Bachelor degree and 5 years consulting experience involving strategic planning, business development and financial management operations OR 8 years of experience strategic planning, market research, network management, or product development in health care industry. + Experience leading and formulating strategy with the ability to build strong connections with people and teams. + Drive results by working across departments in matrixed environment. + Interpersonal skills, including presentation, written and verbal communication. + Experience with business analytics and information synthesis. + Knowledge of strategic planning techniques and industry trends + Able to work within a very fast-paced, quickly evolving organization and manage multiple, complex priorities. + Work directly with corporate leadership. + Analytical, program management and problem solving skills. **Preferred Job Qualifications:** + Advanced degree such as Juris Doctor, MBA, or MHA. + Healthcare and Value Based Care knowledge. + Strong analytical, presentation, skills + Strong Microsoft Office Skills + Ability to present to Leadership complex modeling results. **This is a Flex (Hybrid) role: 3 days in office; 2 days remote.** \#LI-TELECOMMUTE \#LI-SG1 **Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!** **Pay Transparency Statement:** At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting ************************************* . The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan. **HCSC Employment Statement:** We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. **Base Pay Range** $92,700.00 - $167,500.00 Exact compensation may vary based on skills, experience, and location. **Join our talent community and receive the latest HCSC news, content, and be first in line for new job opportunities.** **Join our Talent Community. (******************************************** PA8v\_eHgqFiDb2AuRTqQ)** For more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities. Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren't afraid to make innovative contributions. We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity you'll have to improve health care delivery in an open, collaborative environment. HCSC is committed to diversity in the workplace and to providing equal opportunity to employees and applicants. If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at ************** to request reasonable accommodations. Please note that only **requests for accommodations in the application process** will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "candidate home" to view your job submissions. Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma, and Blue Cross and Blue Shield of Texas, Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, and Independent Licensee of the Blue Cross and Blue Shield Association © Copyright 2025 Health Care Service Corporation. All Rights Reserved.
    $92.7k-167.5k yearly 8d ago
  • Principal Network Management Consultant

    Health Care Service Corporation 4.1company rating

    Chicago, IL jobs

    At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. **Job Summary** This position is hybrid (3 days a week in the office) This Position Is Responsible For Provider Recruitment And Contracting Of Physicians, Physician Groups And Facilities Including Large Or Complex Groups/Facilities (Large Independent Hospital Systems, Integrated & Non-Integrated Systems, Value Based Contracting, Etc). Develop And Negotiate Contracts. Develop And Maintain Relationships With Providers. Ensure Strategic Coverage For Assigned Territory. Responsible For Education Of Providers And For Ongoing Provider Service. Provide Subject Matter Expertise To Improve Efficiencies And Results. Job Description 1.Work with internal departments to ensure appropriate implementation of executed agreements.2.Analyze financial reports to determine financial impact of negotiations.3.Develop and negotiate agreements with providers and facilities (including large independent hospital systems, integrated & non-integrated systems, value based contracting, etc.) within assigned territory of responsibility. 4.Responsible for maintaining a professional relationship with key provider groups. Ensure effective liaison and rapport is developed and maintained through meetings, correspondence and telephone calls.5.Ensure strategic objectives are being met with regard to physicians, physician groups and facilities needed for assigned territory(s). Ensure appropriate provider services including working across departments to resolve issues. 6.Oversee the servicing of facilities, large groups, and/or capitated entities to include assisting with eligibility and capitation issues, contracting issues, and bonus arrangements. Serves as a liaison between internal departments and the capitated entity.7.Work with delegated entities to ensure that providers are loaded correctly. Work closely with the delegation oversight department regarding the delegated entity reporting requirements to include claims delegation, utilization management delegation and credentialing delegation.8.Respond to provider inquiries in an effective and timely manner and assist in claims resolution and payment problems. Must work closely with the Pricing, Full Service Units, Utilization Management, Medical, Delegation Oversight, Core Credentialing, Provider Automation and other divisions within the company.9.Provide leadership regarding negotiation of rates for traditional and managed care business. Conduct and assist in the negotiation process and assure that providers are kept informed of pertinent changes in policies and procedures. Coordinate appropriate education/in-servicing is provided for providers. Education may pertain to managed care and areas where pertinent rulings/regulations could affect business.10.Explain corporate policies and procedures to contracted providers; counsel with provider's staff to ensure their familiarity with Blue Cross procedures.11.Establish and maintain relationships with assigned providers through personal visits, correspondence and telephone calls.12.Serve as a mentor/teacher regarding the activities of staff.13.Serve on local and corporate committees and task forces that require input from Network Management Department. Participate in trade association meetings, as required. 14.Transform fee for service contracts to fee for value.15.Develop reports and analyze performance outcomes. 16.Ensure all expenditures comply with corporate and divisional expense guidelines.17.Communicate and interact effectively and professionally with co-workers, management, customers, etc.18.Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.19.Maintain complete confidentiality of company business.20.Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested. JOB REQUIREMENTS: *Bachelor Degree and 4 years provider contracting experience OR Master degree and 3 years contracting experience OR 8 years business experience including 4 years provider contracting experience. Contracting experience involves negotiating reimbursements, financial arrangements and rates. *Extensive knowledge of provider and facility contracting, products, and claims/processing systems. *Negotiation skills. *Relationship building skills. *Knowledge of marketplace. *Meet deadlines and work well under pressure. *Verbal and written communication skills to interact with all levels of corporate personnel and providers. *PC proficiency to include Microsoft Office. *Analytical skills and business acumen to analyze financial data to determine financial impact of negotiations. *Ability and willingness to travel within assigned areas of responsibility, including overnight stays. **Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!** **Pay Transparency Statement:** At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting ************************************* . The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan. **HCSC Employment Statement:** We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. **Base Pay Range** $90,900.00 - $164,200.00 Exact compensation may vary based on skills, experience, and location. **Join our talent community and receive the latest HCSC news, content, and be first in line for new job opportunities.** **Join our Talent Community. (******************************************** PA8v\_eHgqFiDb2AuRTqQ)** For more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities. Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren't afraid to make innovative contributions. We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity you'll have to improve health care delivery in an open, collaborative environment. HCSC is committed to diversity in the workplace and to providing equal opportunity to employees and applicants. If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at ************** to request reasonable accommodations. Please note that only **requests for accommodations in the application process** will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "candidate home" to view your job submissions. Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma, and Blue Cross and Blue Shield of Texas, Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, and Independent Licensee of the Blue Cross and Blue Shield Association © Copyright 2025 Health Care Service Corporation. All Rights Reserved.
    $90.9k-164.2k yearly 50d ago
  • Sr Business Solutions Consultant

    Health Care Service Corporation 4.1company rating

    Chicago, IL jobs

    At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. **Job Summary** This position is responsible for leading business analysis, ensuring alignment and integration across functional areas in support of divisional strategies, and ensuring consistency and efficiency of major, complex, and strategic cross-divisional and enterprise-wide projects and initiatives from inception to completion. Provides oversight & coordination of project teams, resources, and budget to implement projects or initiatives according to dynamic and critical timelines. Interacts with all levels of management including senior management. Supports the prioritization of transformational program activities and tracks progress to goals. Support writing and executing test cases based on business requirement hands on experience with SQL excel and test management **NOTE: This hybrid role can be located in CHICAGO IL, NASHVILLE, TN or RICHARDSON TX ~ relocation will not be offered; sponsorship is not available.** **Required Job Qualifications:** *** Bachelor's degree and 5 years of experience OR 9 years of experience in business testing, business analysis, process improvement,** project management, business operations or relevant health care industry experience * 3 years of experience leading with large and complex multi-million-dollar projects. * Experience communicating with senior management from multiple divisions. *** Experience developing and delivering presentations.** * Problem resolution experience and skills. * Knowledge of strategic planning techniques and industry trends * Experience interpreting business and financial information * Negotiations skills. *** Verbal and written communications skills including establishing working relationships across departments, preparing presentations to senior management, and establishing team environment.** * Organizational skills. * Experience managing multiple complex projects successfully. * Detail oriented. * PC proficiency to include MS Office products * Knowledge and/or experience with: + **· Medicare Part A/B/D** + · Provider workflows & Provider application - Symplr + · EDI formats - 837 I&P, 276/277, 270/271, 278, 834 + · Member Enrollment - Elements application + · Member Collaterals + · Provider Credentialing - sCRED application + · Claims Intake process + · Claims Adjudication logic - FACETS application + · EOB + · Provider Payments - 835 remittance files & EOP + · CMS reporting + · SalesForce + · Evolve/Broker *** Test case management tools such as Zephyr** * Agile tool such as Jira/Rally * SQL * Health insurance or healthcare industry experience with emphasis on Product/Sales knowledge **Preferred Required Job Qualifications:** * Proven strategic thinking and execution * Ability to drive decisions, create optionality and determine impacts of options \#LI-BS1 \#LI-Hybrid \#INCR **Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!** **Pay Transparency Statement:** At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting ************************************* . The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan. **HCSC Employment Statement:** We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. **Base Pay Range** $82,700.00 - $149,300.00 Exact compensation may vary based on skills, experience, and location. **Join our talent community and receive the latest HCSC news, content, and be first in line for new job opportunities.** **Join our Talent Community. (******************************************** PA8v\_eHgqFiDb2AuRTqQ)** For more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities. Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren't afraid to make innovative contributions. We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity you'll have to improve health care delivery in an open, collaborative environment. HCSC is committed to diversity in the workplace and to providing equal opportunity to employees and applicants. If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at ************** to request reasonable accommodations. Please note that only **requests for accommodations in the application process** will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "candidate home" to view your job submissions. Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma, and Blue Cross and Blue Shield of Texas, Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, and Independent Licensee of the Blue Cross and Blue Shield Association © Copyright 2025 Health Care Service Corporation. All Rights Reserved.
    $82.7k-149.3k yearly 60d+ ago
  • Sr. Consultant (Payer Operations) Optum Advisory - Remote

    Unitedhealth Group Inc. 4.6company rating

    Eden Prairie, MN jobs

    Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together. The Sr. Consultant (Payer Operations) Optum Advisory - Remote works within a team and serves a key role in contributing to the engagement work product as well as project and business management within the delivery team. The Senior Consultant structures and conducts analysis and creates content for assigned workstreams largely independently and contributes to assisting more junior team members with their responsibilities. This role will lead client communications around own workstream and at times those of more junior team members and establish timelines for own work along with assisting junior team members with theirs, in accordance with overall project requirements. This role is a major contributor to team problem solving across full scope of each project. The Sr. Consultant (Payer Strategy) Optum Advisory - Remote will lead or participate in various practice development projects, proactively anticipate challenges and risks in both own area and those of junior staff, make sound adjustments/recommendations to address issues, and play an active role in improving business processes, knowledge management, etc. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. Primary Responsibilities: * Structure approach/analysis for assigned workstream largely independently and contribute to assisting more junior team members with their responsibilities * Lead client communications around own workstream and sometimes those of more junior team members * Major contributor to team problem solving across full scope of project * Able to structure and drive team problem solving sessions with assistance from Project Manager * May serve as project lead for smaller and/or more templated engagements or those in more well-known terrains * Establish self as knowledgeable/credible on topics * Knowledgeable on Optum data sets and tools and carries foundational understanding of health care industry dynamics * Maintain a comprehensive understanding of Health Care research, tools, and assets used by the practice to support client work * Establish own timeline for own workstream and assist junior staff, in accordance with overall project requirements * Lead or participate in various practice development projects * Provide active role in improving business processes, knowledge management, etc. within the practice * Proactively anticipate challenges and risks in both own area and those of more junior staff and make sound adjustments/recommendations to address issues * Communicates effectively and accurately in writing and verbally to prospects, members and other team members You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * 3+ years of relevant health care work experience (healthcare insurance, health care operations or health care management consulting) * 2+ years of experience across multiple lines of health care payer business, including Commercial, Medicare, Medicaid, ACA and Family/Individual coverage, among others * 2+ years of experience in program and operational coordination and management skills - solid tracking, presentation and reporting skills * Ability to work in complex, highly matrixed fast-paced environments * Proven solid interpersonal and relationship management skills * Demonstrated experience in customer or client relationship management * Demonstrated, solid communication (verbal, written) and presentation skills * Proven experience in data analysis and financial analysis * Proven analytical problem-solving skills (identification of issue, causes, solution, implementation plan) * Ability to travel up to 50% Preferred Qualifications: * 2+ years of external client facing experience at a consulting firm (Big 3/Big 4/Big 6/Boutique) * Payment Integrity experience * Proven analytical reasoning and solution-focus problem solving skills * Ability to participate in cross-functional teams * Proven ability to work independently with minimal supervision * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 to $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
    $91.7k-163.7k yearly 6d ago
  • Actuarial Sr Consultant - Remote

    Unitedhealth Group Inc. 4.6company rating

    Eden Prairie, MN jobs

    Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. In joining the Optum Advisory Services Trend Analytics Consulting team: you'll be part of a team that is a leader in health care cost analytics, with a proven track record of supporting health plans across the country through a diverse staff of Actuaries, Data/Research Analysts, and Business/Technology Consultants. Our consulting team has continued to expand capabilities and consulting presence by identifying, developing, and executing on new and exciting business opportunities. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. MN location preferred. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. Primary Responsibilities: * Performing quantitative analysis of healthcare utilization and cost data, preparing client reports, managing project timelines, and coordinating tasks * Developing and analyzing complex datasets for reporting, clearly communicating analytical implications to stakeholders, and collaborating effectively across teams * As a trusted subject matter expert, the consultant will support ad-hoc analytics, foster strategic client relationships, and take ownership of deliverables in a fast-paced environment * This position is part of a high-performing team focused on continuous improvement and innovation, offering clear direction, recognition, and opportunities to apply traditional expertise to cutting-edge actuarial and analytical solutions * Support in the development of junior analysts You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * On the Actuarial exam track, having passed a minimum of 3 or more Actuarial exams * 3+ years hands-on experience in data analysis, data science, data-driven investigations, and/or analytic insight creation for executive consumption * 3+ years of experience handling healthcare claims datasets * 3+ years of experience and an advanced proficiency in SQL, SAS, R, and/or Python, ability to work seamlessly in multiple programming languages * Demonstrated experience using programming to solve complex technical problems * Advanced proficiency in MS Office products: Excel, Word, PowerPoint Preferred Qualifications: * Associate of the Society of Actuaries (ASA) or Fellow of the Society of Actuaries designation (FSA) * 2+ years of experience with medical claims/utilization trend reporting * 1+ years of experience with extracting data from Enterprise Data Warehouses and Enterprise Data Lakes * 1+ years of experience working with actuarial team(s) with an understanding of actuarial concepts * Proven analytical, organizational, and problem-solving skills * Proven ability to handle changing priorities/requirements/deadlines * Local to the Eden Prairie, MN office location for 4 days a week in office work arrangement * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $89,900 to $160,600 annually based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
    $89.9k-160.6k yearly 30d ago
  • Actuarial Sr Consultant - Remote

    Unitedhealth Group 4.6company rating

    Eden Prairie, MN jobs

    Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start **Caring. Connecting. Growing together.** In joining the Optum Advisory Services Trend Analytics Consulting team: you'll be part of a team that is a leader in health care cost analytics, with a proven track record of supporting health plans across the country through a diverse staff of Actuaries, Data/Research Analysts, and Business/Technology Consultants. Our consulting team has continued to expand capabilities and consulting presence by identifying, developing, and executing on new and exciting business opportunities. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. MN location preferred. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. **Primary Responsibilities:** + Performing quantitative analysis of healthcare utilization and cost data, preparing client reports, managing project timelines, and coordinating tasks + Developing and analyzing complex datasets for reporting, clearly communicating analytical implications to stakeholders, and collaborating effectively across teams + As a trusted subject matter expert, the consultant will support ad-hoc analytics, foster strategic client relationships, and take ownership of deliverables in a fast-paced environment + This position is part of a high-performing team focused on continuous improvement and innovation, offering clear direction, recognition, and opportunities to apply traditional expertise to cutting-edge actuarial and analytical solutions + Support in the development of junior analysts You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + On the Actuarial exam track, having passed a minimum of 3 or more Actuarial exams + 3+ years hands-on experience in data analysis, data science, data-driven investigations, and/or analytic insight creation for executive consumption + 3+ years of experience handling healthcare claims datasets + 3+ years of experience and an advanced proficiency in SQL, SAS, R, and/or Python, ability to work seamlessly in multiple programming languages + Demonstrated experience using programming to solve complex technical problems + Advanced proficiency in MS Office products: Excel, Word, PowerPoint **Preferred Qualifications:** + Associate of the Society of Actuaries (ASA) or Fellow of the Society of Actuaries designation (FSA) + 2+ years of experience with medical claims/utilization trend reporting + 1+ years of experience with extracting data from Enterprise Data Warehouses and Enterprise Data Lakes + 1+ years of experience working with actuarial team(s) with an understanding of actuarial concepts + Proven analytical, organizational, and problem-solving skills + Proven ability to handle changing priorities/requirements/deadlines + Local to the Eden Prairie, MN office location for 4 days a week in office work arrangement *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $89,900 to $160,600 annually based on full-time employment. We comply with all minimum wage laws as applicable. **Application Deadline:** This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment._
    $89.9k-160.6k yearly 60d+ ago
  • EDW Medicaid Subject Matter Expert or Data Specialist - Remote

    Unitedhealth Group Inc. 4.6company rating

    Chicago, IL jobs

    Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. This position is a Medicaid Subject Matter (SME) Expert for the Enterprise Data Warehouse supporting the State Medicaid program. This role requires significant expertise of Medicaid Enterprise System modules and data warehousing or decision support systems. This role provides the guidance and direction to support a large data warehouse implementation and maintenance & operations. The selected SME will provide the required decisions for the business and technical team members to modify, change, enhance or correct within the system, related to claims, provider, and recipient data. Roles in this function will partner with stakeholders to understand data requirements and support development tools and models such as interfaces, dashboards, data visualizations, decision aids and business case analysis to support the organization. Additional roles include producing and managing the delivery of activity, value analytics and critical deliverables to external stakeholders and clients. This is a telecommute position with some ( You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. Primary Responsibilities: * Provide direction, guidance and recommendations supporting decision making for large Medicaid data warehouse implementation and operations * With the specialized knowledge of the Medicaid and Children's Health Insurance Programs (CHIP), lead and guide internal and external stakeholders to make determinations relating to complex processes involving claims processing/adjudication, recipient eligibility, provider enrollment, and third-party liability * Proactively identify and understand state Medicaid agency data needs and determines the recommended solution to meet them with credible reason, justification and validated proof of concepts * Direct technical and business teams on healthcare topics understanding and utilizing healthcare data appropriately * Proactively suggest and recommend enhancements and improvements throughout the project processes, driven by Medicaid best practices, standards and policies You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * 10+ years of experience in information technology with 5+ years of experience working directly with/for State Medicaid agencies or equivalent supporting business initiatives through data analysis, writing business requirements and testing/validation of various systems * 2+ years of experience working CMS Federal Reporting MARS, PERM, T-MSIS, Quality of Care CMS Core Measure or similar projects * Knowledge of the Centers for Medicare and Medicaid Services reporting requirements and the programs covered * Understanding of claims, recipient/eligibility, and provider/enrollment data processes * Proven ability to create and perform data analysis using SQL, Excel against data warehouses utilizing large datasets * Proven excellent verbal/written communication and presentation skills, manager/executive/director-level client facing, team collaboration, and mentoring skills * Proven solid culture fit, demonstrating our culture values in action (Integrity, Compassion, Inclusion, Relationships, Innovation, and Performance) * Ability to travel to Springfield, IL two (3) to three (4) times per year or as needed Note: Core customer business hours to conduct work is M-F 8 AM - 5 PM CST. Preferred Qualifications: * 2+ years of experience in HEDIS, CHIPRA or similar quality metrics * Experience with data analysis using Teradata Database Management System or other equivalent database management system * Experience using JIRA, Rally, DevOps or equivalent * Experience in large implementation or DDI project * Located within driving distance (3 - 5 Hours) of Springfield, IL * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $110,200 to $188,800 annually based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
    $54k-75k yearly est. 60d+ ago

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