BlueCross BlueShield of South Carolina
Location
Columbia, SC | United States
Job description
Summary
Description
Join us and be part of the National Alliance team that provides world-class service for health plan members nationwide. A division of BlueCross BlueShield of South Carolina, National Alliance builds partnerships with other Blue plans across the United States to offer health plan administration for self-funded accounts. Learn more at .
Location: Columbia, SC
What You'll Do:
Analyzes data supporting procedures and processes in area. Developing reporting methodologies to track current and future payment integrity efforts for internal and external customers. Analyzes reports to ensure accuracy and quality. Tracks and verifies all reporting statistics and/or metrics.
Apply business rules to monthly program activities and coordinate downstream tasks by working collaboratively with internal departments. Consolidate data from multiple stakeholders to build rules to support area. Design, code and maintain programs for the extraction and analysis of data.
Present the findings through reports and presentations conveying value of the payment integrity program to external stakeholders.
Collaborate with internal stakeholders to develop comprehensive marketing messaging related to payment integrity efforts.
Analyze performance trends and assist with identifying new opportunities to streamline processes and improve performance of key metrics. Recommend new process based on data and best practices.
Required Education:
Bachelor's degree
Required Work Experience:
6 years data analysis experience and 5 years of claims experience (may be concurrent)
Required Skills and Abilities:
Proven ability to apply quantitative and/or qualitative research and data analysis techniques to improve operational processes.
Required Software and Other Tools:
Advance level experience with Excel and other data systems.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.
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Equal Employment Opportunity Statement
BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.
We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.
If you need special assistance or an accommodation while seeking employment, please e-mail [email protected] or call 1-800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.
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