Neighborhood Health Plan of Rhode Island jobs - 25 jobs

The Sales-Marketing Associate is responsible for the recruitment and retention of all Neighborhood product lines. The key to success in this position is to have strong community relationships as well as to ensure that members and prospective members are educated on benefits and enrollment processes. The Associate will be responsible for sharing data with the Marketing department and/or other internal departments and external partners. The Sales-Marketing Associate will significantly impact the growth of new members through the use of data collections, community and provider outreach and member satisfaction information. This person must have significant community involvement as well as contacts in the community, an avenue to recruit new members. Ensure adherence to Center for Medicare and Medicaid Services (CMS) guidelines in all aspects of sales activities. This person will significantly impact the growth of new members through relationship building within the community, delivering educational and sales presentations, and providing applications assistance. This position will be required to be licensed within the State of Rhode Island under the "Broker License" in support of State licensing requirements governing our commercial insurance lines of business. The handling of Medicaid and/or Duals potential member calls will require strict adherence to pre-approved scripts and procedures. The Associate has a direct impact on driving membership growth, providing high quality service with a professional, respectful demeanor while meeting the appropriate needs of any potential member. Duties and Responsibilities: Responsibilities include, but are not limited to the following: Sell, market, and promote products within all lines of business by coordinating and delivering sales/marketing presentations to consumer groups, social service agencies, churches, schools, food pantries, facilities that service seniors (centers, assisted living facilities, adult day care centers), community events, make outbound calls to prospective leads, arrange provide appointments in potential homes for our duals program and other sites as designated. Very often the first "Face of Neighborhood" for potential members in the community, requiring a professional and empathetic tone and exceptional level of plan knowledge. Report daily duties and responsibilities to Marketing Sales Outreach Supervisor Communicate any issues that arise when out in the community to Supervisor Seek new outreach opportunities for all lines of business Coordinate and present at special events including open houses, fundraisers, outreach and community events, provider offices, exhibits, product or service fairs, and school events Present plan information to potential eligible Medicare Medicaid, Medicaid and Commercial members Assist potential, eligible members to determine what Neighborhood product is best for them. Educate enrollees on all aspects of the Plan, as well as answering questions regarding Plan's features and benefits Assist with Medicare Medicaid application process for potential eligible Medicare Medicaid members. Understand and apply all policies and procedure pertaining to: Disclosures and provisions of the Neighborhood Medicare product Enrollment and disenrollment Marketing and Sales rules and regulations The covered benefits, non-covered benefits, exclusions and exemptions Document consistently and accurately all activities including community presentation, sponsorships, potential member leads, sales activities, etc. in Salesforce. Maintain significant community involvement as well as contacts in the community as an avenue to recruit new members. Establish and maintain a positive working relationship with facility and site staff community and provider organizations, as well as City and State regulatory agencies Gather data, compile information, prepare reports and for the overall analysis of data as it relates to the marketing department. Respond to requests for information from the public; distributes promotional materials, including flyers, brochures and press kits; prepares and presents information to internal and external sources Conduct or assist in portions of market research activities to identify targeted populations, including potential sponsors, and to identify the appropriate media for distribution of promotional information Maintain database records and files including mailing and potential member information Keep informed and adhere to current information pertaining to marketing activity guidelines set forth by various regulatory agencies-this includes providing enrollees with all corresponding materials and documentation Develop a comprehensive outreach strategy for the means of recruiting and outreaching new members of Color (BIPOC) communities Cross-department partnerships to identify strategies to maintain membership. Maintain strong relationships with Inside Sales and Member Services to ensure follow-up on potential member leads, resolve member concerns regarding complaints and potential enrollments and/or disenrollments. Assist with inbound and outbound potential member calls when necessary Follows compliance standards for new lines of business to minimize errors Works in accordance with departments compliance-related policies and procedures Adhere to all Centers for Medicare & Medicaid Services (CMS) guidelines and company driven compliance programs, including the Annual Medicare Training Perform other duties as assigned Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhood's Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies, and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect, and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents. Qualifications Qualifications: Required: Bachelor's degree and/or five (5) years equivalent marketing and sales work experience Must possess a valid Rhode Island Brokers License for health insurance within (6) six months of hire Excellent written/communication skills with phone and/or customer service experience Strong facilitation and presentation skills Knowledge of marketing strategies, processes, and available community resources Flexibility in work schedule to work nights and weekends to meet the needs of members and potential members Ability to effectively prioritize and implement tasks in a high-pressure environment and reliably meet deadlines Ability to use independent judgment to plan, organize and coordinate special events Ability to gather data, compiles information, and prepares reports Intermediate to advanced skills in Microsoft Office (Excel, Outlook, PowerPoint, Word) Ability to travel for work. Must have own vehicle and possess a valid driver's license and proof of auto insurance Ability to lift up to 40lbs and carry items up to 200 feet Preferred: Bilingual Experience working health insurance sales with a proven track record of success Knowledge of Rhode Island Medicaid Knowledge of CMS (Center for Medicare and Medicaid Services) marketing rules and regulations Possession of Rhode Island Brokers License Experience working with Salesforce Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.

The Data Governance Engineer plays a pivotal role in ensuring the integrity, quality, and security of organizational data assets. This position will collaborate with various teams across the organization to establish and enforce data governance policies, standards, and procedures. Responsibilities include identifying data quality issues, implementing data governance frameworks, and driving initiatives to improve data management practices. This role requires a strong understanding of data governance principles, excellent analytical skills, and the ability to communicate effectively with stakeholders at all levels. Duties and Responsibilities: Responsibilities include, but are not limited to: Design, implement, and maintain data governance frameworks, policies, and procedures to ensure compliance with regulatory requirements and organizational standards. Monitor and assess data quality issues, establish data quality metrics, and develop strategies to improve data accuracy, completeness, and consistency. Classify data assets based on sensitivity and criticality, establish metadata standards, and implement metadata management processes to enhance data discoverability and usability. Collaborate with cross-functional teams, including IT, legal, compliance, and business units, to define data governance requirements, resolve data-related issues, and promote a culture of data stewardship. Ensure compliance with data privacy regulations (e.g., HIPAA) by implementing data access controls, encryption mechanisms, and data anonymization techniques to protect sensitive information. Evaluate, select, and implement data governance tools and technologies to support data governance initiatives, such as data cataloging, data lineage, and data quality monitoring. Generate and distribute regular reports on data governance activities, including data quality assessments, compliance audits, and remediation efforts, to senior management and stakeholders. Identify opportunities for process improvement, automation, and optimization of data governance workflows to enhance efficiency and effectiveness. Other duties as assigned by Manager Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhood's Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies, and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect, and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents. Qualifications Qualifications Required: Bachelor's degree in computer science, information technology, data management, or a related study, or equivalent combination of education and relevant work experience Minimum of three (3) years of experience in data governance, data management, or related fields, with a deep understanding of data governance principles, practices, and methodologies Strong analytical skills with the ability to analyze complex data sets, identify trends, and recommend solutions to improve data quality and governance Proficiency in data governance tools and technologies, such as data cataloging tools, metadata management platforms, and data quality tools (e.g., Spirion, MS Purview) Excellent communication skills with the ability to effectively collaborate with stakeholders at all levels, translate technical concepts into business terms, and influence decision-making processes Knowledge of data privacy regulations (e.g., HIPAA) and experience implementing data privacy and security controls Excellent communication skills Strong attention to detail, organizational skills, analytical and problem-solving skills and ability to manage multiple priorities in a fast-paced environment Preferred: Experience working in regulated industries (e.g., healthcare) with a focus on data governance and compliance. Familiarity with data management best practices, data modeling techniques, and data architecture principles. Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.

Pay Range: $64,600.00 - $96,800.00 Please email HR_Talent_************************** if you are a candidate seeking a reasonable accommodation for the application and/or interview process. At BCBSRI, our greatest resource is our people. We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do-not just for our members, but for our employees as well. We recognize that to do your best work, you have to be your best self. It's why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health, dental, and vision insurance as well as programs that support your mental health and well-being. We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees. Our culture is one of belonging. We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where you're at in the organization, you're an integral part of our team and your input, thoughts, and ideas are valued. Join others who value a workplace for all. We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders. We're dedicated to serving Rhode Islanders. Our focus extends beyond providing access to high-quality, affordable, and equitable care. To further improve the health and well-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities all across the state-building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can, our associates receive additional paid time to volunteer. Why this job matters: Perform daily operations of provider education as it pertains to Risk Revenue and Quality department. Execute the development, implementation, and maintenance of departmental policies, procedures, and programs. What you will do: Coordinate with ACOs on common strategies to improve quality, coding, and health equity. Work with the analytics team to set metrics to measure the success of the program and monitor progress of individual providers. Works with the analytics team and ACO leadership to identify providers who would benefit from a provider education program and prioritize engagement. Takes feedback from ACO and internal leadership to focus on areas of educational need and improve process Stays up-to-date on the latest ICD-10 guidelines, OIG Letters, CMS guidance, and Coding Clinics and is able to relay that information internally and externally. Creates training material to distribute externally to ACOs. Works with the coding education manager to improve accuracy and ensure material has relevance to organizational goals. Provide virtual and/or onsite presentations on chart reviews and various topics related to quality improvement to clinicians, staff, and leadership. Works with the internal and external teams to develop individualized presentations and plans for providers. Ability to analyze risks in documentation, billing, and quality and implement a plan to mitigate those risks through intervention. Utilize analytical thinking to assess coding data and trends. Review basic analytic reports to evaluate coding accuracy and efficiency. Present analytic findings and insights during provider training sessions to inform and improve coding practices Works with the coding education manager to maintain a schedule of provider education visits to maintain a routine in order to provide timely feedback to clinicians. Execute the development, implementation, and maintenance of departmental policies, procedures, and programs. Perform other duties as assigned. What you need to succeed: CPC and CRC coding certification from AAPC, CCS coding certification from AHIMA Three to five years of experience in provider education, HCC coding, and care management years provider education experience 3+ years of experience in healthcare. Proven analytic experience using Microsoft Excel, database query capabilities and ability to evaluate data at various levels of detail Strong and effective decision-making skills Excellent organizational skills and ability to successfully prioritize multiple tasks Proficiency with Microsoft Suite of products (i.e., Word, Excel, PPT, etc.) Ability to effectively interact with all levels of the organization Excellent verbal and written communication skills, with ability to convey complex or technical information in an effective manner Proficiency in ICD/10-CM medical coding Advanced analytical skills, with the ability to interpret and synthesize basic data sets Knowledge of business process improvement techniques and strategies Negotiation skills Presentation skills Ability to effectively navigate ambiguous situations with limited direction The extras: Bachelor's degree or an equivalent combination of education and experience Location: BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role: In-office: onsite 5 days per week Hybrid: onsite 2-4 days per week Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia Our culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do, and it strengthens our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity employer. The law requires an employer to post notices describing the Federal laws. Please visit ************************************************************** to view the "Know Your Rights" poster.

Pay Range: $54,400.00 - $71,400.00 Please email HR_Talent_************************** if you are a candidate seeking a reasonable accommodation for the application and/or interview process. At BCBSRI, our greatest resource is our people. We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do-not just for our members, but for our employees as well. We recognize that to do your best work, you have to be your best self. It's why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health, dental, and vision insurance as well as programs that support your mental health and well-being. We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees. Our culture is one of belonging. We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where you're at in the organization, you're an integral part of our team and your input, thoughts, and ideas are valued. Join others who value a workplace for all. We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders. We're dedicated to serving Rhode Islanders. Our focus extends beyond providing access to high-quality, affordable, and equitable care. To further improve the health and well-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities all across the state-building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can, our associates receive additional paid time to volunteer. What you will do: Respond to member phone calls and conduct outreach calls to identified members; facilitate problem resolution through research. Refer call to appropriate resources in a timely manner. Promote health management programs and provide community resources available to members; utilize engagement skills and motivational interviewing techniques to enroll members in programs. Maintain supportive communication with the member via the member's channel preference (phone, web, e-mail, mail); provide education, monitor and reporting compliance, identify gaps in care, and adjust the plan as needed. Consult with internal clinical staff as needed when assessment or gaps in care indicate increasing severity of the member's condition requiring more intense monitoring and intervention. Consult with other clinical staff (dietician, behavioral health clinician, medical director) on an as needed basis. Participate in ongoing quality improvement initiatives and overall department efficiencies. Assist team with department initiatives and projects. Perform other duties as assigned. What you'll need to succeed: Associate's or Bachelor's degree in Business Management, Healthcare Administration, or Unrestricted Rhode Island LPN or LVN Nursing License; or an equivalent combination of education and experience Two to four years' experience in a health-related position The extras: Engagement and sales skills necessary for enrolling members into health management programs Persuasive skills required to negotiate, develop, influence, motivate, and move others through the stages of behavior change Interpersonal skills in order to interact effectively with internal and external customers Ability to research data, identify trends and recommend appropriate actions Detail oriented Ability to work successfully in a matrix environment Demonstrated written and verbal communications skills Ability to exercise sound judgment Ability to establish and maintain strong working relationships with various stakeholders Ability to organize work efficiently to meet established time and quality standards Good organization skills Good time management skills Proficiency with Microsoft Suite of products; i.e., Word, Excel, PPT, etc Location: BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role: In-office: onsite 5 days per week Hybrid: onsite 2-4 days per week Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia Our culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do, and it strengthens our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity employer. The law requires an employer to post notices describing the Federal laws. Please visit ************************************************************** to view the "Know Your Rights" poster.

Pay Range: $73,500.00 - $110,300.00 Please email HR_Talent_************************** if you are a candidate seeking a reasonable accommodation for the application and/or interview process. At BCBSRI, our greatest resource is our people. We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do-not just for our members, but for our employees as well. We recognize that to do your best work, you have to be your best self. It's why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health, dental, and vision insurance as well as programs that support your mental health and well-being. We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees. Our culture is one of belonging. We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where you're at in the organization, you're an integral part of our team and your input, thoughts, and ideas are valued. Join others who value a workplace for all. We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders. We're dedicated to serving Rhode Islanders. Our focus extends beyond providing access to high-quality, affordable, and equitable care. To further improve the health and well-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities all across the state-building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can, our associates receive additional paid time to volunteer. Why this job matters: Supervise the daily work of staff to ensure adherence to quality standards, deadlines, and proper procedures. Oversee key performance items measured in service levels and account performance guarantees. Provide performance management oversight and employee development. Manage workflow of department; implement corporate or departmental policies, procedures, and service standards. Assist in external audits preparation and follow up. Assist with completing RFP (request for proposal) responses related to performance guarantees. What you will do: Coordinate the workflow and operations of the performance monitoring team. Provide direction and guidance to staff. Review and evaluate work and prepare performance reviews. Direct the day-to-day operations of the performance monitoring team in its efforts to monitor the key performance items measured in the service level program, and account performance guarantees. Investigate declines in performance and oversee resolution with key operational areas to improve performance on account performance guarantees. Oversee implementation of account performance guarantee reporting. Oversee analysis of reporting and data capabilities to develop and implement selections of possible account performance guarantees that are measurable, achievable and consistent with internal standards and reporting capabilities. Develop and update standard contract language regarding the methodology used to measure and report the guarantees. Ensure that reports are generated, analyzed and provided to the account via BCBSRI Sales department where such guarantees exist. Collaborate with internal areas to identify existing guarantees and transition all accounts to standard guarantees where possible. Notify appropriate vendor manager of changes in guarantees that relate to vendor PGs/ SLAs. Assist with completing performance guarantee-related responses to RFPs. Update and maintain a database/tracking system to monitor performance issues identified through non-regulatory external audits and performance monitoring reports. Facilitate the resolution of all issues identified. Communicate performance issues with potential negative impact to internal departments. Perform other duties as assigned. What you need to succeed: A combination of education and related work experience Three to five years' experience in auditing and/or account performance function Knowledge of health care financing, operational functions and auditing requirements Knowledge of Blue Cross Blue Shield Association requirements related to operational performance Understanding of contractual agreements and effects on operational performance Ability to set and maintain quality standards Ability to develop and maintain effective and collaborative working relationships Strong and effective decision-making skills Strong organizational and time management skills Proficiency with Microsoft Suite of products (i.e., Word, Excel, PPT, etc.) The extras: Bachelor's degree in Business Administration, Accounting, Finance, or related field, or an equivalent combination of education and experience Supervisory experience or experience leading a team Location: BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role: In-office: onsite 5 days per week Hybrid: onsite 2-4 days per week Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia Our culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do, and it strengthens our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity employer. The law requires an employer to post notices describing the Federal laws. Please visit ************************************************************** to view the "Know Your Rights" poster.

This position is responsible for development and management of fee schedules, including sample schedules, and alternative payment methodologies (APM) that support strategic and corporate goals. This position develops provider reimbursement mechanisms using industry standards and in alignment with state and corporate financial initiatives and recommends areas for optimization. Oversees the end-to-end rate development processes for new, revised and deleted Current Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding System (HCPCS) codes; the implementation of systemic fee schedules and rate tables and ensures that fee schedules are configured in accordance with best practice. This position develops and maintains department fee schedule dashboards, reports and/or, presentations and conducts research to ensure financial information has been configured accurately; identifies trends and developments in competitive environments and presents findings to management. Duties and Responsibilities: Responsibilities include, but not limited to: * Responsible for provider reimbursement rate development for professional, institutional, ancillary and LTSS providers, ongoing analysis of current reimbursement models, schedules, and proposed changes * Responsible for the creation and maintenance of fee schedules, including but not limited to, sample fee schedules and standardized metrics for the quantification of quality, value and cost * Responsible to research and articulate current and emergent provider payment models and changes with the health care industry * Responsible for the creation of provider financial modeling to support alternative payment methodologies and reimbursement proposals in alignment with strategic and corporate goals * Development of payment hierarchy, gathering of business requirements and auditing of claim processing system(s) to ensure system configuration supports accurate fee schedule and default implementation; process changes as necessary * Completes complex and ad-hoc analyses and reporting * Represents the department at cross-functional meetings * Responsible for provider fee schedule auditing * Coordinates activities with auditors and actuaries, as applicable * Attends provider negotiations, as requested by management * Performs other duties as assigned * Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhoods Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies, and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect, and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents

Pay Range: $64,600.00 - $96,800.00 Please email HR_Talent_************************** if you are a candidate seeking a reasonable accommodation for the application and/or interview process. At BCBSRI, our greatest resource is our people. We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do-not just for our members, but for our employees as well. We recognize that to do your best work, you have to be your best self. It's why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health, dental, and vision insurance as well as programs that support your mental health and well-being. We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees. Our culture is one of belonging. We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where you're at in the organization, you're an integral part of our team and your input, thoughts, and ideas are valued. Join others who value a workplace for all. We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders. We're dedicated to serving Rhode Islanders. Our focus extends beyond providing access to high-quality, affordable, and equitable care. To further improve the health and well-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities all across the state-building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can, our associates receive additional paid time to volunteer. What you will do: 2 - 3 Days On-Site in Providence, RI Collaborate with appropriate stakeholders to track, measure, report and evaluate vendor classification status, Tier II program and any additional data related strategies adopted for the program. Identify and attend engagement opportunities to ensure a comprehensive vendor pool Manage, review and respond to inquiries from various internal channels Work with the marketing and communications teams to maintain and update relevant content on the company's intranet and website Identify qualified, prospective small and prospective vendors that are representative of a comprehensive enterprise ecosystem, inclusive of certified non-traditional suppliers, socially disadvantaged, small and historically underutilized enterprises and facilitates introductory discussions with procurement associates and/or business owners Develop relationships with internal stakeholders to ensure understanding of and engagement with supplier engagement & innovation initiatives and provide consultative support to internal business owners to design, streamline, and manage the engagement with vendors. Work with internal and external stakeholders to assist in the development of a supplier engagement & innovation training, mentoring and networking program Seek out, identify and execute on participation of local events and opportunities (i.e. trade shows, markets, educational seminars, web tutorials etc.) Perform other duties as assigned. What you'll need to succeed: Bachelor's degree in business management, communications, or related field; or an equivalent combination of education and experience Five or more years of experience in supply chain management, supplier engagement, small business support, data analytics The extras: Experience building relationships with business and business stakeholders Knowledge of BCBSRI business activities or previous healthcare industry experience Strategic and critical thinking skills Strong analytical skills and ability to interpret the data to communicate trends and best practices Strong business acumen and political savvy Strong negotiation skills Strong problem-solving skills Ability to work effectively with a wide variety of people in individual and group settings Strong organizing skills, with the ability to prioritize and respond to shifting deadlines and work independently Strong time management skills Strong attention to details Ability to manage diverse and deadline-oriented workflow Work effectively with a diverse workforce Travel required Location: BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role: In-office: onsite 5 days per week Hybrid: onsite 2-4 days per week Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia Our culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do, and it strengthens our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity employer. The law requires an employer to post notices describing the Federal laws. Please visit ************************************************************** to view the "Know Your Rights" poster.

Pay Range: $73,500.00 - $110,300.00 Please email HR_Talent_************************** if you are a candidate seeking a reasonable accommodation for the application and/or interview process. At BCBSRI, our greatest resource is our people. We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do-not just for our members, but for our employees as well. We recognize that to do your best work, you have to be your best self. It's why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health, dental, and vision insurance as well as programs that support your mental health and well-being. We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees. Our culture is one of belonging. We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where you're at in the organization, you're an integral part of our team and your input, thoughts, and ideas are valued. Join others who value a workplace for all. We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders. We're dedicated to serving Rhode Islanders. Our focus extends beyond providing access to high-quality, affordable, and equitable care. To further improve the health and well-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities all across the state-building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can, our associates receive additional paid time to volunteer. What you will do: Conduct pre and post payment review of inpatient admissions, outpatient services, and other procedures to assess the appropriateness and continuity of care. Apply all aspects of the medical review function, including pre-authorization, concurrent review, screening for quality-of-care issues, and discharge planning. Document rationale for medical decisions made. Identify at-risk members who would benefit from health management programs through comprehensive health assessments. Monitor and evaluate patient's plan of care and identify potential issues through telephonic outreach. Recommend appropriate interventions. Promote member and provider satisfaction. Provide continuity and consistency of care by building positive relationships between member and family, physicians, provider, care coordinator, and health care plan. Represent corporation in a responsible and professional manner. Participate in department initiatives and projects. Perform other duties as assigned. What you'll need to succeed: Active and unrestricted RN license issued by a state participating in the Nurse Licensure Compact (NLC) Three to five years acute medical or clinical experience or experience in utilization reviewed. Valid Driver's License (On-site only) Understanding of utilization review techniques including all aspects of the medical review function, including pre-authorization, concurrent review and discharge planning Understanding of health care delivery system access points and services Correct application of health care management guidelines Ability to navigate the healthcare delivery system Advanced analytical skills, with the ability to interpret and synthesize complex data sets Good business acumen and political savvy Knowledge of business process improvement techniques and strategies Excellent verbal and written communications skills Negotiation skills Presentation skills Decision-making skills Good problem-solving skills Ability to interface with employees at all levels Ability to effectively navigate ambiguous situations with limited direction Excellent organizational skills and ability to successfully prioritize multiple tasks Ability to handle multiple priorities/projects The extras: Bachelor's Degree in Nursing Certified Case Management certification, Certified Professional Utilization Review certification Experience working in a managed care/health maintenance organization Location: BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role: In-office: onsite 5 days per week Hybrid: onsite 2-4 days per week Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia Our culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do, and it strengthens our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity employer. The law requires an employer to post notices describing the Federal laws. Please visit ************************************************************** to view the "Know Your Rights" poster.

Pay Range: $64,600.00 - $96,800.00 Please email HR_Talent_************************** if you are a candidate seeking a reasonable accommodation for the application and/or interview process. At BCBSRI, our greatest resource is our people. We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do-not just for our members, but for our employees as well. We recognize that to do your best work, you have to be your best self. It's why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health, dental, and vision insurance as well as programs that support your mental health and well-being. We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees. Our culture is one of belonging. We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where you're at in the organization, you're an integral part of our team and your input, thoughts, and ideas are valued. Join others who value a workplace for all. We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders. We're dedicated to serving Rhode Islanders. Our focus extends beyond providing access to high-quality, affordable, and equitable care. To further improve the health and well-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities all across the state-building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can, our associates receive additional paid time to volunteer. What you will do: Pharmacy Benefit Expertise Serve as a subject matter expert on pharmacy benefit design and trend management; respond to inquiries regarding prescription coverage and member utilization. Cross-Functional Collaboration Work with internal teams (Sales, Marketing, Customer Service & Care Management) to triage and research customer needs, analyze market dynamics, and integrate strategies into the pharmacy benefit toolkit. Employer Group Support Deliver in person presentations and program performance updates; analyze data and track adoption of benefit options and coordinate cost-saving initiatives across departments. PBM Partnership, Program Optimization & RFP Compliance Collaborate with PBM and internal teams to enhance reporting tools, optimize programs, and ensure compliance with benefit design and regulatory requirements. Gather and validate data for RFPs, ensuring accurate, timely responses to assigned questions. Claims Adjudication Oversight Review pharmacy benefit rules, resolve coverage issues, and ensure accurate adjudication of claims in alignment with benefit design. Administrative & Communication Management Support P&T Committee functions, manage internal requests and member outreach, and facilitate communication between pharmacists and providers for care coordination. In Person Presentations and Department Meeting Must have the ability to work onsite for internal department meetings and offsite for external client meetings and presentations. Additional Responsibilities Perform other duties as assigned to maintain high-quality, cost-effective pharmacy benefit operations. What you'll need to succeed: Knowledge of formularies, drug rebate contracts, and pharmacy benefit design Knowledge of cost containment and utilization review strategies Analytical skills specific to pharmacy utilization management and/or project management. Strong communication, interpersonal and presentation skills. Proficient in Microsoft Office applications (i.e. Excel, PowerPoint) The extras: Combination of education and applicable experience Three to five years' experience in managed care or a pharmacy or related healthcare field. Specific knowledge and exposure to prescription drugs, pharmacy benefits, utilization review, cost containment strategies, and emerging technology. Experience with group level presentation and financial analysis reporting on pharmacy trends and benefit performance. Location: BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role: In-office: onsite 5 days per week Hybrid: onsite 2-4 days per week Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia Our culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do, and it strengthens our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity employer. The law requires an employer to post notices describing the Federal laws. Please visit ************************************************************** to view the "Know Your Rights" poster.

The Senior Production Support Analyst is a senior level position that provides front-line support of Neighborhood's production healthcare systems, interfaces, inbound and outbound file processing. Works closely with cross-functional, providers, vendors, SQL/DW, business and IT teams to troubleshoot, identify root cause, and resolve technical issues related to job failures in job scheduling systems and interfaces, including EDI and non-EDI compliant files. This role closely monitors email boxes that includes internal, provider and vendor requests, research root cause and resolution; documents and communicates effectively and timely. In addition, this role coordinates vendor ticket management and change management processes. Duties and Responsibilities: Responsibilities include, but are not limited to the following: * Troubleshoot and resolve failed jobs in Production job schedulers (ActiveBatch, TransSend, etc.), production interface connections, and monitor healthcare systems performance * Analyze EDI and non-EDI compliant files in various formats, .txt, csv, html, including SOAP * Monitor shared email boxes (EDI Support, PEC) and creates Jira tickets to be triaged * Analyze, research, and resolve assigned Jira tickets such as healthcare system access requests or issues, missing files/reports, SFTP connection issues, file transfer requests and other requests/issues * Owns assigned Jira tickets: research, determine root cause and resolution, update and close tickets per Service Level Agreements (SLAs) * Create or update existing "how to" documentation with resolution steps * Collaborate with business, IT and production support teams, Production Support Lead, management and vendors * Work with providers/vendors as needed to set up an electronic interface. Responsible for testing, certifying', and post-production support * Monitor all integration systems to proactively identify and resolve issues * Identify process improvement opportunities * Own/participate in vendor management calls, vendor ticket lists, meeting notes, follow-ups (internally and with vendor), ensures accurate vendor ticket updates, and other assigned tasks * Create support tickets vendor ticketing systems and updates Jira tickets with Vendor ticket information * Own/participate in the Change Control Management process, facilitates meetings and coordinates activities * Take directions from Production Support Lead and Manager of Production Support on priorities, work assignments and processes * Communicate statuses effectively and timely with requestors, Production Support Lead (and Manager of Production Support when requested) and escalates issues or work stoppages * Participate in meetings and/or projects, as assigned * Other duties as assigned * Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhood's Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents

Pay Range: $98,100.00 - $163,400.00 Please email HR_Talent_************************** if you are a candidate seeking a reasonable accommodation for the application and/or interview process. At BCBSRI, our greatest resource is our people. We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do-not just for our members, but for our employees as well. We recognize that to do your best work, you have to be your best self. It's why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health, dental, and vision insurance as well as programs that support your mental health and well-being. We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees. Our culture is one of belonging. We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where you're at in the organization, you're an integral part of our team and your input, thoughts, and ideas are valued. Join others who value a workplace for all. We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders. We're dedicated to serving Rhode Islanders. Our focus extends beyond providing access to high-quality, affordable, and equitable care. To further improve the health and well-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities all across the state-building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can, our associates receive additional paid time to volunteer. What you will do: Lead the extraction and analysis of health care data for specific studies and corporate initiatives related to the Total Cost of Care. Lead data intensive projects related to data exchanges with contracted clinical vendors; Serve as a technical resource to department staff and management on technical issues; Develop and improve automated processes to increase the efficiency and accuracy of work products. What you'll need to succeed: Develop deep understanding of claims, eligibility and provider data to support clinical vendor implementations and ongoing relationships. Perform data extraction and mapping activities in alignment with vendor program specifications. Collaborate with vendors to define necessary inbound data elements and facilitate their integration into BCBSRI data structures. Drive data discussions to ensure “minimum necessary” data is provided to fully support clinical programs. Present and defend data requirements at internal Data Governance Committee. Triage data discrepancies and expeditiously resolve inconsistencies. Perform complex analytical work of health care data. Utilize data to provide insights about customers and prospects to support the growth of various market segments. Initiate and lead data intensive projects; translate quantitative findings into practical insights through the interpretation of data, trends and other sources. Prepare project results or recommendations for a wide range of audiences using written reports and presentation exhibits/graphics. Conduct special data extraction and analysis studies. Summarize results and provide recommendations where appropriate. Design, implement, and maintain various databases as assigned; develop reporting capabilities and ensure data quality and documentation is adequate. Identify areas where operational efficiency can be improved through enhanced automation. Collaborate with technical staff on implementation of enhancements. Communicate necessary changes and enhancements to all internal/external customers. Represent the organization at external meetings. Provide recommendations and input to new contract provisions for performance guarantees. Respond to various Requests for Implementation as requested by marketing staff. Perform special studies as needed. Perform other duties as assigned. Bachelor's degree in Computer Science, Mathematics, Economics, or related field; or an equivalent combination of education and experience Seven to ten years health data analysis, business analysis, software application, database design, and technical documentation experience, preferably in the health insurance industry Successfully pass the Wolfe Spence Programmer Aptitude test Knowledge of claims processing and membership processing for all BCBSRI lines of business The extras: Knowledge of applied statistics Knowledge of econometric modeling Knowledge of marketing analytic principles and modeling Experience utilizing competitive intelligence Knowledge of CPT-4 and ICD-9 coding and covered benefits Understanding of SAS programming, spreadsheet, and database software and other application development tools Knowledge of general mathematical principals Working knowledge of Business Objects and Windows Understanding of micro and mainframe computer systems Strong business acumen and political savvy Ability to lead and manage projects Ability to collaborate while dealing with complex situations Ability to think creatively and to drive innovation Ability to motivate, lead and inspire a diverse group to a common goal/solution with multiple stakeholders Ability to convert business strategy into action-oriented objectives and measurable results Strong negotiating, influencing, and consensus-building skills Ability to mentor, coach and provide guidance to others Location: BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role: In-office: onsite 5 days per week Hybrid: onsite 2-4 days per week Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia Our culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do, and it strengthens our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity employer. The law requires an employer to post notices describing the Federal laws. Please visit ************************************************************** to view the "Know Your Rights" poster.

Under the direct supervision of the Manager of Pharmacy Operations, the Pharmacy Technician will perform various, assigned administrative operational functions within the Pharmacy department. This position is directly involved with day-to-day operations of the department and is responsible for conducting and coordinating multiple facets of the prescription drug prior authorization (PA) process. The duties associated with this position include PA order entry, updating PAs within the pharmacy claims system, tracking and reporting PA activity and processing PA notifications to members and providers. The position requires a working knowledge and familiarity with prescription drugs. The position works closely with Neighborhoods Medical Management, Grievance & Appeals Unit, claims department, vendors, and Member and Provider service teams. The position requires excellent verbal communication skills and a demonstrated ability to work in an organized, timely, efficient and thorough manner. Duties and Responsibilities: Responsibilities include, but are not limited to the following: * Independently coordinates and processes pharmacy prior authorizations (PA) taking into consideration pharmacy benefits, medication utilization policies, information submitted by prescriber accurately and in a timely manner and in accordance with departmental policy and procedures. * Triage, document and prioritize incoming calls and requests while following established protocols Utilize plans reporting capabilities to collect and analyze claims and drug utilization data. * Interacts with internal plan departments to address pharmacy related issues. * Researches pended claims and authorizations and corrects issues when applicable. * Responds to inquiries from physicians, members, and pharmacies related to formulary and prescription benefits. * Audits processed pharmacy claims to ensure appropriate adjudication while verifying compliance with benefit design and regulatory requirements for all lines of business. * Demonstrates proficiency in all pharmacy claims systems. * Collaborates with Plans contracted PBM in regards to PAs, overrides, and issue resolution. * Conducts outbound calls to resolve prescription issues pertaining to prescription coverage, claim rejections, etc. * Ensures all member information is kept confidential according to HIPAA regulations. * Conducts quality assurance measures as assigned. * Participates in onboarding and training activities of new employees. * Other duties as assigned by the Vice President of Pharmacy or Pharmacy Management. * Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhoods Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents

Senior Cyber Security Analyst is an experienced cyber security individual who maintains the security of an organization's technical environment. They study existing security hardware and software, evaluate new security options and makes recommendations for improvement. Senior Cyber Security Analyst also identifies weak spots in a cyber security system that may be breached and creates procedures to manage threats. Senior Cyber Security Analyst monitors networks for suspicious activity and potential cyber threats. They keep up on threat intelligence, install and maintain security software and encryption. They are responsible for aiding in the planning of security systems, implementing policy and identifying business processes that may violate intended and acceptable use policies. They monitor and remediate vulnerabilities. Senior Cyber Security Analyst works on advanced, complex technical projects or business issues requiring state of the art technical or industry knowledge. Duties and Responsibilities Responsibilities include, but are not limited to the following: * Assist in developing, operating, and evolving Cloud Access Security solutions and capabilities * Performs system security administration on designated technology platforms, including operating systems, applications and network security devices, in accordance with the defined policies, standards and procedures of the organization, as well as with industry best practices and vendor guidelines * Performs installation and configuration management of security systems and applications, including policy assessment and compliance tools, network security appliances and host-based security systems * Performs threat and vulnerability assessments, followed by appropriate remedial action, to ensure that systems are protected from known and potential threats and are free from known vulnerabilities Research, recommend, and implement streamlined automation processes * Develops and maintains documentation for security systems and procedures * Conducts network monitoring and intrusion detection analysis using various computer network defense tools, such as intrusion detection/prevention systems, firewalls and host-based security systems * Provide support to one or more projects simultaneously. Delivers projects on schedule * Deploys cloud-centric detection to detect threats related to cloud environments and services used by the organization * Assists and trains junior team members in the use of security tools, the preparation of security reports and the resolution of security issues * Applies patches where appropriate and, removes or otherwise mitigates known control weaknesses, such as unnecessary services or applications or redundant user accounts, as a means of hardening systems in accordance with security policies and standards Correlates activity across assets (endpoint, network, apps) and environments (on-premises, cloud) to identify patterns of anomalous activity * Using threat intelligence information research emerging threats and vulnerabilities to aid in the identification of incidents * Job Knowledge - Remains up-to-date in assigned area of responsibility: possesses skills and knowledge to perform job effectively; efficiently and safely; acquires, understands, and applies technical and professional information and skills; understands and adheres to policies and procedures * Supports the creation of security incident response, business continuity/disaster recovery plans, including conducting tests, publishing test results and making changes necessary to address deficiencies * Analyzes problems and alternative solutions and takes appropriate timely action to achieve desired business results. Seeks unique and novel solutions to problems and considers impact of final resolution * Perform security standards testing against computers before implementation to ensure security * Provide Key Performance Metrics to our Risk Management team to help coordinate risk tracking. * Educate internal teams on information security best practices. * Assist in technical audits of IT Systems and controls. * Other duties as assigned. * Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhood's Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents

Pay Range: $73,500.00 - $110,300.00 Please email HR_Talent_************************** if you are a candidate seeking a reasonable accommodation for the application and/or interview process. At BCBSRI, our greatest resource is our people. We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do-not just for our members, but for our employees as well. We recognize that to do your best work, you have to be your best self. It's why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health, dental, and vision insurance as well as programs that support your mental health and well-being. We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees. Our culture is one of belonging. We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where you're at in the organization, you're an integral part of our team and your input, thoughts, and ideas are valued. Join others who value a workplace for all. We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders. We're dedicated to serving Rhode Islanders. Our focus extends beyond providing access to high-quality, affordable, and equitable care. To further improve the health and well-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities all across the state-building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can, our associates receive additional paid time to volunteer. What you will do: Manage members through the healthcare delivery system; assess needs in order to identify appropriate interventions. Conduct telephonic or face to face health assessments to identify high risk or emerging risk members who would benefit from education and intervention. Facilitate communication between members, providers, and stakeholders to coordinate and implement action plans aimed at improving the members' total health. Identify opportunities to impact claims expense trends for the all lines of business/or at the individual member level. Evaluate action plans by working with members, and collaborating with providers. Modify action plans as necessary. Monitor and evaluate patient services to ensure appropriate coordination of care. Collaborate with the Utilization Review process including pre-authorization, concurrent review, screening cases for quality of care issues, and discharge planning. Promote member and provider satisfaction by demonstrating working knowledge of member benefits, including but not limited to health, disability, employee Assistance or other plans/benefits available to the member Provide continuity and consistency of care by building positive relationships between the member and family, physicians, provider, care coordinator, and health care plan. Work collaboratively with the team and others necessary to develop and implement solutions. Identify barriers to performing job duties as well as opportunities for improvements. Exemplifying the corporate values in action through accountability, collaboration, integrity and respect in maintaining a high performance culture. Participate in department initiatives and projects. Perform other duties as assigned. What you'll need to succeed: A combination of education and related work experience Active and unrestricted RN license issued by a state participating in the Nurse Licensure Compact (NLC) Three to five years' experience in a medical/clinical environment or managed health plan Expertise working with D-SNP beneficiaries Must obtain Certified Case Manager (CCM) certification within three years of employment *Applies to positions working with FEP product only Knowledge of utilization management and/or coordination of care Knowledge of population health and chronic condition management principles Understanding of health care delivery system access points and services Ability to navigate the healthcare delivery system Good business acumen Knowledge of business process improvement techniques and strategies Excellent verbal, written communications and technical skills Negotiation skills Presentation skills Decision-making skills Good problem solving skills Ability to interface with employees at all levels Ability to effectively navigate ambiguous situations with limited direction Excellent organizational skills and ability to successfully prioritize multiple tasks Ability to handle multiple priorities/projects Strong time management skills The extras: Professional nursing certification Experience working in a managed care/health maintenance organization Bilingual preferred Location: BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role: In-office: onsite 5 days per week Hybrid: onsite 2-4 days per week Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia Our culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do, and it strengthens our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity employer. The law requires an employer to post notices describing the Federal laws. Please visit ************************************************************** to view the "Know Your Rights" poster.

Pay Range: $52,600.00 - $78,900.00 Please email HR_Talent_************************** if you are a candidate seeking a reasonable accommodation for the application and/or interview process. At BCBSRI, our greatest resource is our people. We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do-not just for our members, but for our employees as well. We recognize that to do your best work, you have to be your best self. It's why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health, dental, and vision insurance as well as programs that support your mental health and well-being. We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees. Our culture is one of belonging. We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where you're at in the organization, you're an integral part of our team and your input, thoughts, and ideas are valued. Join others who value a workplace for all. We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders. We're dedicated to serving Rhode Islanders. Our focus extends beyond providing access to high-quality, affordable, and equitable care. To further improve the health and well-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities all across the state-building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can, our associates receive additional paid time to volunteer. What you will do: Assist in the development, maintenance, and preparation of dashboards, reports, and supporting materials, ensuring accuracy, completeness, and alignment with Finance Operations requirements. Support Finance project and governance processes, including intake tracking, documentation review, data validation, and preparation of materials for governance meetings. Maintain logs and governance documentation to ensure compliance with established standards. Assist and maintain benchmarking and reference materials to support continuous improvement efforts within Finance Operations. Compile comparative analyses and support the development of reporting tools. Assist in the preparation of financial and operational information needed for internal reviews, leadership presentations, and corporate reporting using spreadsheets, charts, and presentation graphics. Support department initiatives and projects related to operating model updates, workflow improvements, and financial process enhancements. Assist with the preparation of financial data on a routine basis, and monitor and evaluate on a routine basis for management reporting/review. Support investigation of deviations from expectations and assist in recommending adjustments. Conduct mathematically based analyses to provide financial and operational information to Finance leadership. Analyze data using quantitative methods and apply appropriate analytical techniques. Assist team with department initiatives and projects. Perform other duties as assigned. What you'll need to succeed: Bachelor's degree in Finance, Accounting, Business Administration, Economics, or related field; or an equivalent combination of education and work experience One to three years' experience in financial analysis, business operations, quantitative analysis, or related work (internships accepted). The extras: Familiarity with Workday Finance or other ERP systems. Experience supporting financial governance, budgeting, or operations reporting a plus. Knowledge of financial statement analysis Knowledge of managerial accounting Understanding of mathematical theories and methodologies Ability to research data, identify trends and recommend appropriate actions High level of attention to detail, accuracy and quality - both in analysis and in the visual presentation of information Strong communication skills, including the ability to develop a clear narrative or “story” around financial and operational insights Ability to translate data into clear, concise, and visually effective presentations, dashboards, or exhibits that enhance understanding for leadership audiences Strong proficiency with technology and an ability to quickly learn, navigate, and apply new systems, tools, and applications (e.g. Workday, collaboration platforms, data tools, etc.) Ability to work successfully in a matrix environment Ability to exercise sound judgment and maintain confidentiality Demonstrated initiative in finding solutions to complex or sensitive issues Ability to establish and maintain strong working relationships with various stakeholders Ability to organize work efficiently to meet established time and quality standards Good organization skills Good time management skills Advanced skills in Microsoft Excel, PowerPoint, and other analytical and presentation tools Proficiency with Microsoft Suite of products, i.e., Word, SharePoint, Co-Pilot etc. Location: BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role: In-office: onsite 5 days per week Hybrid: onsite 2-4 days per week Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia Our culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do, and it strengthens our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity employer. The law requires an employer to post notices describing the Federal laws. Please visit ************************************************************** to view the "Know Your Rights" poster.

Pay Range: $127,600.00 - $212,500.00 Please email HR_Talent_************************** if you are a candidate seeking a reasonable accommodation for the application and/or interview process. At BCBSRI, our greatest resource is our people. We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do-not just for our members, but for our employees as well. We recognize that to do your best work, you have to be your best self. It's why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health, dental, and vision insurance as well as programs that support your mental health and well-being. We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees. Our culture is one of belonging. We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where you're at in the organization, you're an integral part of our team and your input, thoughts, and ideas are valued. Join others who value a workplace for all. We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders. We're dedicated to serving Rhode Islanders. Our focus extends beyond providing access to high-quality, affordable, and equitable care. To further improve the health and well-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities all across the state-building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can, our associates receive additional paid time to volunteer. Why this job matters: The Senior Enterprise Data Architect will serve as the strategic and technical leader responsible for designing and governing the enterprise's next-generation data architecture. This role will focus on unifying data across multiple operational and analytical domains (such as clinical, claims, provider, demographic, and engagement data) to support advanced analytics, personalization, and enterprise decision-making. This role will establish the conceptual, logical, and physical architecture needed to deliver a holistic and longitudinal view, working closely with internal stakeholders and external vendor engineers. The ideal candidate brings deep expertise in modern cloud data platforms, specifically Snowflake, data warehousing, ELT, and excels at setting architectural standards, overseeing a distributed delivery team, and ensuring high-quality outcomes from vendor partners. This role focuses on designing, governing, and guiding the implementation of new data capabilities, data models, identity resolution, and integration patterns. What you will do: Lead enterprise data architecture and modeling: Define the architectural vision, standards, and conceptual/logical/physical models that unify data across clinical, claims, provider, demographic, and engagement domains. Provide technical leadership and drive vendor delivery teams: Guide external engineering teams in implementing pipelines, transformations, and models aligned with architectural standards. Conduct design reviews, enforce best practices, and ensure quality, performance, and cost efficiency in Snowflake. Translate business needs into scalable architectures: Partner with stakeholders across IT, analytics, clinical, and operations to convert requirements into actionable roadmaps and technical designs. Champion modern cloud data engineering patterns: Promote Snowflake-native and cloud-native design patterns including semi-structured/unstructured data handling, streaming ingestion, and cost/performance optimization. Strengthen governance & data quality: Collaborate with governance and security teams to define metadata standards, lineage practices, PHI protection, and stewardship models. What you need to succeed: Bachelor's degree in Computer Science, Information Science, or related field, or equivalent experience. 10 or more years of experience in data architecture, data engineering, or related disciplines. 10 or more years of experience designing logical and physical data models for complex, cross-domain environments (relational, dimensional, and/or canonical). 8 or more years influencing enterprise-level technical architecture decisions. Experience with modern ELT/ELT development patterns, data orchestration methodologies, and cloud-native architecture best practices. Technical Hands-on, advanced expertise with Snowflake as a cloud data platform, including advanced features (Snowpipe, Streams & Tasks, performance optimization, and governance capabilities). Experience with modern ELT tools such as Matillion, dbt, or similar. Strong experience with modern storage paradigms - NoSQL, data lakes, unstructured content management. Strong experience with modern integration patterns - APIs, FHIR, event streaming, real-time data flows. Advanced knowledge of industry-leading BI tools (such as Power BI) Strong experience with layered/lakehouse architectures (e.g., raw/bronze, conformed/silver, curated/gold). Strong background in designing canonical models, conformed dimensions, and large-scale data integration patterns. Business Experience in healthcare or health insurance industry, especially with claims, clinical, provider, and member data. Strong business acumen, including the ability to understand operational, clinical, and analytical workflows. Demonstrated ability to lead and manage day‑to‑day work of vendor or offshore engineering teams. Strong leadership and communication skills with the ability to influence stakeholders, mentor technical teams, and drive clarity in complex data environments. Creativity and innovation in developing modern data solutions. The extras: Master's degree in Information Systems, Engineering, Computer Science, or related field. Experience with healthcare administrative systems (e.g., Facets) is a plus. Experience with HL7 / FHIR / healthcare interoperability standards Experience building or governing data products Experience with data governance and cost optimization in cloud ecosystems Location: BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role: In-office: onsite 5 days per week Hybrid: onsite 2-4 days per week Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia Our culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do, and it strengthens our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity employer. The law requires an employer to post notices describing the Federal laws. Please visit ************************************************************** to view the "Know Your Rights" poster.

The Senior Contract Administrator is responsible for the end-to-end contracting process including, contract strategy development and negotiation through to execution with an emphasis on complex, high profile negotiations. This position develops, facilitates and implements provider negotiation strategies that support strategic and corporate goals. This position is responsible for the ongoing monitoring and management of contract terms including claims system configuration, contract oversight and adherence to all managed care health plan requirements. Provides support in the absence of a manager. Duties and Responsibilities: Responsibilities include, but are not limited to: * Responsible for complex, high profile negotiations, including the development, proposal and implementation of contractual terms as approved * Leads negotiations to completion and execute contractual relationships to align with specific corporate and department initiatives, strategic goals and objectives. Responsible for the accuracy of all contract and rate proposals and final contracts. Ensuring reimbursement is accurately defined, communicated and configured while maintaining network adequacy and member access to care standards and all Plan contractual requirements * Monitoring of contractual requirements through the ongoing management of contract terms including claims system configuration, contract oversight and adherence to all managed care health plan requirements * Assists in the development of the vision and strategy for the department and assigned functions including the identification, recommendation and recruitment of providers * Cultivates strong business relationships internally and externally * Ensures that providers receive appropriate and timely responses * Identifies and implements medical expense savings opportunities * Leads and collaborates departmentally and cross-organizationally in the development and planning of provider contracting initiatives and efficient business processes including recommending modifications to policy and procedures, processes, workflows and communication strategies * Provides assistance and mentorship to the Contract Administrator and support in the absence of the Manager * Provides reporting to internal and external parties * Represents the organization in appropriate internal and external committees and meetings and facilitate internal and external meetings, as required * Serves as the lead subject matter expert ensuring optimal efficiency in area of responsibility * Understands, proposes and implements various industry standard reimbursement methodologies as approved * Works collaboratively with provider relations to understand operational issues, providing assistance in the satisfactory resolutions as needed * Maintains professional growth and development * Works on special projects and other duties as assigned * Responsible for complying with Neighborhoods Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents

**Details** _Kemper is one of the nation's leading specialized insurers. Our success is a direct reflection of the talented and diverse people who make a positive difference in the lives of our customers every day. We believe a high-performing culture, valuable opportunities for personal development and professional challenge, and a healthy work-life balance can be highly motivating and productive. Kemper's products and services are making a real difference to our customers, who have unique and evolving needs. By joining our team, you are helping to provide an experience to our stakeholders that delivers on our promises._ Kemper is seeking a Senior Guidewire BillingCenter Developer. This role provides leadership for multiple areas within BillingCenter and the associated integrations. **Position Responsibilities:** + Provides technical support for multiple BillingCenter functions and integrations. + Develops, documents and executes unit test cases. + Delivers quality and timely results. + Owns and resolves complex technical problems and issues with assigned applications and work processes. + Review and recommend test plans for impacted areas and end to end test coverage. + Complies with and supports all corporate, department and team policies and procedures. + Keeps manager, project teams/managers and business customers informed of activities and problems within assigned areas of responsibility; refers matters beyond limits of authority to manager for direction. + Recommends improvements to existing processes or proposes new ones, to improve the quality of project deliverables. + Ensure reviews for quality (accurate and complete) of application software designs are scheduled and conducted to ensure optimal use of software systems. + Consults with internal and external customers on the utilization of applications computing technologies, within areas of expertise, to ensure that customers optimize the value of those technologies. + Leads projects across technical disciplines; plans for the appropriate resources needed. + Develop technical knowledge and performance skills of IT projects teams for multiple scopes. + Researches, evaluates and recommends new technologies independently or with the architect's implementation. + Implement and support proof-of-concept activities for new technologies. + Develops and obtains sign offs on technical specs, design documents, functional designs and requirements. + Guide teams on long term solutions for resolving frequently occurring production problems and reducing defect leakage. + Ensure code is being developed per standards with focus on maintainability and ensure unit test cases are being developed, documented and executed with the test results recorded. Ensure that the technical design presented by the architects is followed by the software development staff. + Ensure batch cycles are being executed according to plan and that defects are resolved in an accurate and timely fashion. + Lead team in successful completion of phase gates for projects. **Position Qualifications:** + 8 years of developer experience + Bachelor's degree, equivalent work experience or appropriate technical certification. + 5 years extensive experience with Guidewire Insurance Suite + 3 recent years of ongoing BillingCenter experience. + P&C Non-Standard Auto Insurance experience preferred. + Experience in technical disciplines such as Java/Spring, JavaScript, HTML/CSS, Angular, Hibernate, SQL, JSON/XML, REST Web Services, Git/SVN, Jenkins, Oracle & SQL + Experience with cloud development practices. + Advanced certifications for coding/development. Current Guidewire Certified Ace preferred. + Demonstrates advanced technical skills. Advanced knowledge of a gosu and a good knowledge of related languages. + The ability to provide technical leadership on large/complex application installation, development and support projects; Advanced knowledge of program design methods and techniques and standard development tools. + Use knowledge of new frameworks, tools and languages and make recommendations in applications as appropriate. + Ability to understand and identify improvement areas in architecture and integration designs + Ability to teach and provide instruction to co-workers and provide feedback on progress toward goals. + Demonstrates excellent leadership qualities in managing the work of a team of professional employees. + Able to follow and create best practice development standards. + Worked with various project methodologies (agile and waterfall). + Able to translate business to technical requirements. + Requires minimal managerial direction. + Understands technical controls, security concepts and SOX requirements. + This role is eligible for remote work in the US. The range for this position is $89,000 to $148,100. When determining candidate offers, we consider experience, skills, education, certifications, and geographic location among other factors. This job is eligible for an annual discretionary bonus and Kemper benefits (Medical, Dental, Vision, PTO, 401k, etc.) _Kemper is proud to be an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran, disability status or any other status protected by the laws or regulations in the locations where we operate. We are committed to supporting diversity and equality across our organization and we work diligently to maintain a workplace free from discrimination._ _Kemper does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Kemper and Kemper will not be obligated to pay a placement fee._ Kemper will never request personal information, such as your social security number or banking information, via text or email. Additionally, Kemper does not use external messaging applications like WireApp or Skype to communicate with candidates. If you receive such a message, delete it. \#LI-AK-1 \#LI-REMOTE **Kemper at a Glance** The Kemper family of companies is one of the nation's leading specialized insurers. With approximately $12 billion in assets, Kemper is improving the world of insurance by providing affordable and easy-to-use personalized solutions to individuals, families and businesses through its Kemper Auto and Kemper Life brands. Kemper serves over 4.6 million policies, is represented by approximately 24,200 agents and brokers, and has approximately 7,500 associates dedicated to meeting the ever-changing needs of its customers. *Alliance United Insurance Company is not rated. _We value diversity and strive to be an employer of choice. An Equal Opportunity Employer, M/F/D/V_ **Our employees enjoy great benefits:** - Qualify for your choice of health and dental plans within your first month. - Save for your future with robust 401(k) match, Health Spending Accounts and various retirement plans. - Learn and Grow with our Tuition Assistance Program, paid certifications and continuing education programs. - Contribute to your community through United Way and volunteer programs. - Balance your life with generous paid time off and business casual dress. - Get employee discounts for shopping, dining and travel through Kemper Perks.

The Enrollment Analyst is responsible for all eligibility and enrollment functions related to membership enrollment and disenrollment including the processing of Electronic Data Interchange (EDI) files, analyzing error reports and trends ands and identifying solutions to ensure data accuracy and integrity. This position presents an integrated view of enrollment with all levels of Management and external partners while supporting the mission, vision, and value of the organization. Duties and Responsibilities: Responsibilities include, but are not limited to, the following: Processes enrollment data for membership with accuracy which may include researching membership eligibility through contract review and benefit criteria requirements. Analyzes data on Electronic Data Interchange (EDI) files by converting files through EDI power reader or Map Force into excel, and running macros to identify which members require updates and ensure eligibility reconciliation. Completes EDI reviews, identify discrepancies and research processing solutions. Generates Cognos reports and recommend updates for additional Cognos reporting through Business Analytics team to increase department efficiencies. Generates enrollment activity reports for both internal and external customers. Analyzes error reports and trends from 834 files against delegated entity membership. Provides FDR Eligibility oversight of delegated entities for EDI review through conversion of 834 files into readable format. Communicates with Executive Office of Health & Human Services (EOHHS); Department of Children, Youth & Family Services (DCYF); Health Source RI (HSR) and HP on a daily basis to resolve enrollment issues. Handles all functions related to Benefit Coordination, Outreach, Reporting and member disenrollment while identifying process improvement and workflow efficiencies. Additional responsibilities include: Perform quality audits for enrollment changes to maintain data integrity. This includes reporting births to EOHHA and COB Train new staff members and non-enrollment staff as required Performs other duties as assigned Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhoods Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents Qualifications Qualifications Required: High School or GED Minimum of 3-5 years Health Plan/HMO experience. Previous position in Enrollment strongly preferred 1 year experience with EDI process and 834 benefit enrollment strongly preferred Excellent organizational, problem-solving and analytical skills Strong verbal and written communications skills for interaction with internal and external clients. Experience working independently, and as a team player while handling multiple responsibilities and meeting timelines Previous experience analyzing data and developing reports Proficiency in Microsoft Office Suite Preferred: Associates degree in Business or Health related area Experience working with EDI and/or 834 files Core Company-Wide Competencies: Communicate Effectively Respect Others & Value Diversity Analyze Issues & Solve Problems Drive for Customer Success Manage Performance, Productivity & Results Develop Flexibility & Achieve Change Job Specific Competencies: Collaborate & Foster Teamwork Influence & Negotiate Attend to Detail & Improve Quality Exercise Sound Judgement & Decision Making FDR Oversight: Business Lead Level: In the role of business lead for assigned FDR; incumbent is responsible to complete comprehensive oversight and monitoring of their vendor that incorporates the following elements: efficient and effective operations; compliance with laws, regulations, policies, procedures; and other company performance issues designed to reduce risk and add value to the company Salary Grade: D Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.