About Blue Cross
At Blue Cross, we understand the importance of finding a job that you truly enjoy — at a company that shares your values. We’ve made it easy to feel good about working at Blue Cross by encouraging volunteerism, valuing diversity and offering the flexibility you need to live a balanced life. We offer a suite of comprehensive medical and dental benefits as well as competitive pay, flexible work schedules and generous personal paid time off in addition to 20 hours of volunteer paid time off each year. We look forward to serving Minnesotans over the next 80 years and beyond. Join us and make a healthy difference through the work you do every day.
Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.9 million members. We’re committed to reinventing health care to improve health for our members and the community. We hope you'll join us.
How Is This Role Important to Our Work:
This position supports the Payment Integrity team across all products leveraging data and analytics to identify Payment Integrity opportunities. This individual will be accountable for ideation analytics, reporting to validate outcomes, operational reporting for all products, reporting for external customers, and oversight of system development.
A Day in the Life:
- Manage a team of analysts to support the Payment Integrity process, including ideation efforts
- Assume responsibility for budgeting and resourcing.
- Create technical solutions, while partnering with Payment Integrity Operations leadership to identify the business requirements and the expected outcomes.
- Support the goals of the team by driving innovation using data and analytics.
- Create an operational reporting discipline to enable Payment Integrity product owners to manage their business.
- Recruit employees to ensure department is staffed with qualified personnel. Interface with leadership and key partners across the organization about Payment Integrity efforts.
- Develop integrated reporting to demonstrate results to our key stakeholders.
- Ensure work is completed with the highest level of integrity.
- Supports, communicates and takes personal ownership of vision, strategy and success criteria. Actively assesses perspective from all levels while challenging the status quo to ensure a successful execution plan.
- Demonstrates the capacity to effectively manage changing priorities and ambiguity, minimizing the impact on peers and team members. Maintains direction and focus through proactive planning and organized approaches.
- Drives business excellence through establishing partnerships with internal and external stakeholders. Demonstrates dedication to meeting expectations and requirements for both internal and external customers and creates an environment suitable for team members to do the same.
- Achieves business excellence by establishing management priorities, defining performance measures, creating and utilizing key metrics and performance indicators to measure service levels. Collaborates with peers to provide the data and analytics solution to help them access dashboards and reports to manage and achieve their business goals.
- Drives talent development in a way that builds and supports current and future organizational goals and individual needs. Establishes a strategy and systems to recruit, retain and engage talented individuals. Leads the development of data, analytics, and technology infrastructure strategy, architecture, and service delivery standards and procedures for the enterprise.
- Develops short and long term data, analytics and technology strategies, tactics, implementation plans and projects to ensure continuous stability of an enterprise environment that aligns with the overall strategy and business objectives.
- Manages the department including interviewing and hiring employees following required EEO and Affirmative Action guidelines and ensuring employees receive the proper training. Conducts performance evaluation, and is responsible for managing employees, including skill and career development.
Nice to Have:
- 5+ years of experience in Payment Integrity Function
Required Skills & Experiences:
- Bachelor’s degree in Business Administration, Finance, Economics, Mathematics, Health Administration or a related field
- 8 years of experience working with healthcare data, both structured and unstructured, including a demonstrated ability to design, evaluate and interpret complex data sets.
- 8 years of experience using SAS or other similar analytics suite of tools.
- 3 years of staff, team lead or project lead experience.
- The ability to communicate complex problems and solutions in simple language that all can understand.
- Understanding of the differences between
- Commercial, Medicaid and Medicare business within the payer space.
- Demonstrated analytic and problem-solving skills.
- Ability to develop an analytically derived idea into a proposed program plan.
- Ability to work in a matrixed team environment.
- Ability to work across all areas of the business.
- Proficiency in Microsoft Office suite.
- Ability to perform validation techniques as well as perform and interpret a variety of statistical analyses.