Job Description

Summary

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Description

Position Purpose:

Responsible for managing claims data initiatives that support risk adjustment and population health programs across ACA, Medicare Advantage, and Medicaid. Leads and coordinates projects involving data management, reporting, system enhancements, and process improvements to ensure regulatory compliance, data accuracy, and operational effectiveness. Collaborates with stakeholders, supports the implementation of new systems and technologies, provides training on complex changes, and serves as a resource and mentor to less experienced staff.

Location: This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 7:00AM-6:00PM. This role is located at 4101 Percival Road, Columbia, SC 29229.

Sponsorship: This position is not eligible for sponsorship now or in the future.

What You’ll Do:

• Leads planning and implementation of projects to include coordinating the development and implementation of project and procedural enhancements, data gathering, process analyses, procedural documentation, leading development teams, training management and non-management staff, and establishing processes to monitor and sustain effective changes.
• Facilitates the definition of project missions, goals, tasks, and resource requirements, service levels and customer requirements. Communicates with information systems and internal staff relative to project assigned. Provides continuity between groups through attendance and participation in work sessions, scope and design walkthroughs and weekly status meetings.
• Manages project budget and resource allocation. Administers scheduling, planning, reporting, development and implementation within timelines and budgets. Provides technical and functional assistance to project team members during all project phases.
• Functions as lead in reviewing proposed enhancements and identifying issues related to project business requirements. Resolves or assists in the resolution of conflicts within and between projects or functional areas. Directs testing and coordination of changes/enhancements. Oversee the development of test matrices and coordination of internal and external personnel for testing of implemented changes.
• Provides training and documentation to customers and staff related to project status, procedures and changes. Provides education and training regarding policies and procedures that are changed or developed as a result of changes and projects. Generates internal and external reports to support management in determining productivity and efficiencies of programs or operational processes. Analyzes processes to ensure accuracy and quality. Makes recommendations to improve processes and drive efficiency in quality. Assists in the identification of potential cost savings. Completes other tasks assigned by management.

To Qualify For This Position, You'll Need The Following:

Required Education:

• Bachelor's degree

Degree Equivalency:

• 4 years job-related work experience OR
• Associate's degree AND 2 years of job-related work experience

Required Experience:

• 7 years of progressively responsible experience working in various functional areas, such as operations, research and analysis, project management, strategic planning, business process engineering or quality improvement.
• 3 years’ experience coordinating or leading project teams from inception through implementation phases (may be concurrent).

Required Software and tools:

• Microsoft Office

Required Skills and Abilities:

• Excellent and effective communication and time-management skills.
• Strong knowledge of business process engineering methodology.
• Ability to communicate complex information with understanding to a variety of audiences who have different levels of experience and knowledge.
• Advanced analytical and decision-making skills.
• Thorough understanding of project management phases, techniques and tools.
• Demonstrated aptitude for effective leadership of staff. Ability to recognize problems or situations that are new or without clear precedent and offer solutions.

We Prefer That You Have The Following:

Preferred Work Experience:

• Minimum 1 year of experience in the healthcare or insurance industry.
• Experience managing projects involving data file integration, implementation, and ongoing maintenance.

Preferred Skills and Abilities:

• Strong vendor management and coordination skills, with the ability to oversee cross-functional initiatives and deliverables.
• Working knowledge of SQL, including the ability to create and run simple queries to retrieve, analyze, and validate data.
• Proficiency in Microsoft Excel

Our Comprehensive Benefits Package Includes The Following:

We offer our employees great benefits and rewards. You will be eligible to participate in our benefits program the first of the month following 28 days of employment.  

• Subsidized health plans, dental and vision coverage
• 401k retirement savings plan with company match
• Life Insurance
• Paid Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Education Assistance
• Service Recognition

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 individuals with disabilities and protected 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 disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 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.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information.

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