Arkansas Blue Cross and Blue Shield

Software Engineer

• Consults with users to identify current operating procedures and to clarify project objectives.
• Contributes to and supports the Enterprise strategic and operational planning process including total quality management philosophies.
• Designs, testable code and develops test protocols or plans and reviews revisions and results.
• Designs and develops high-volume, low-latency applications for mission-critical systems and delivers high-availability and performance applications.
• Develops and implements processes to ensure accurate and effective workflow distribution.
• Develops applications and creates deliverables aligned with processes and enterprise standards.
• Enhances and applies programming analysis, design, coding, testing, debugging, implementation and documentation.
• Provides technical expertise of subsystems and any other performance related systems.
• Uses standard application design principles to create logical and physical application designs to promote efficiency and code reuse.

Developer

Analyst

• Serve as the point of contact between IT and end users.
• Responsible for incident resolution by restoring services as quickly as possible or escalation to the appropriate IT resource and incident logging and categorization.
• Responsible for request fulfillment support and knowledge management, providing users with guidance and support for their IT needs.
• Assists in the incorporation, installation, training, support and coordination of new and ongoing projects that involve several teams.

IT Service Desk Analyst – Associate

Program Manager

• Compiles reporting related to the performance and continuous improvement of Utilization Management (UM), Care Management (CM) and vendor programs.
• Collaborates across clinical, operational and analytic teams for all lines of business to ensure compliant and high quality member centered outcomes.
• Supports program monitoring, reporting, vendor performance management, and execution of internal operational improvements and vendor oversight for compliance requirements.

Manager, Clinical Program Management – Vendor Performance

• Assisting with all Medicare Advantage (MA) compliance activities.
• Managing operations of Compliance, including components of administration, interpretation, and enforcement of the Compliance Program.
• Managing regulatory affairs, prevention, detection, and correction functions of Compliance.
• Continually analyzing business needs, identify potential problems, ensure effective lines of communicating business and compliance issues, and assist in remediation.
• Develops and maintains strong working relationships, collaborating and consulting with business and regulatory partners.
• Develops and oversees a system for uniform response, enforcement and corrective action on matters relating to MA compliance.
• Ensures that employees are trained on ABCBS’ commitment to compliance with all applicable federal and state laws and regulations.

Program Manager, Medicare Compliance

Actuary

• Analyzes financial, statistical and mathematical data to perform actuarial calculations.
• Assists in the determination of pricing, reserves and/or cash flow projections, especially to determine rate accuracy.
• Assists with the Division's Annual Statement exhibits.
• Communicates financial, statistical, and mathematical data results to stakeholders clearly and accurately.
• Demonstrates ability to meet deadlines while providing management adequate time to review the work product.
• Maintains good standing as a participant in the Actuarial Development Program.
• Prepares and distributes established reports for decision-makers throughout the Enterprise, responding to inquiries as needed.
• Prioritizes work projects according to Enterprise needs with moderate input from management.
• Provides analytic support for Enterprise and/or Divisional projects, Enterprise Risk Management, and other requests.
• Retrieves and validates data for rate filings, actuarial models, and other requests as assigned.
• Updates rating model factors, algorithms and studies to reflect current experience and/or changing conditions.

Actuarial Analyst

Customer Support

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Customer Service Representative

• Communicates in a clear and concise manner (whether orally or in writing) using business English and Spanish, correct grammar, and precise vocabulary; learns to make complex insurance topics accessible to a wide audience and explain benefits without resorting to jargon; develops the ability to listen, comprehend what is being said, and ask appropriate questions that help lead to issue resolution; and keeps accurate and complete electronic notes of conversations in the appropriate software systems.
• Interacts directly with customers, which may include members, groups, and providers to resolve issues related to the products and services and health insurance plans offered by ABCBS and its family of companies; and completes interactions based on company standards and directives as well as within state and federal guidelines such as the privacy rules enumerated in HIPAA guidelines.
• Always conducts him/herself in a positive and professional manner, addressing others with politeness, etiquette, and tact; handles confrontational situations with empathy but also in such a manner as to reach fact-based objective conclusions and resolve; and gains conclusive agreement through negotiation.
• Becomes an expert on benefits and eligibility for health insurance plans supported by multiple lines of business, as requested; and knows where and how to find information pertinent to providing superior customer service.

Bilingual Customer Service Representative

• Consults with users to identify current operating procedures and to clarify project objectives.
• Contributes to and supports the Enterprise business solutions strategic and operational planning process.
• Designs, testable code and develops test protocols or plans and reviews revisions and results.
• Designs and develops high-volume, low-latency applications for mission-critical systems.
• Develops and implements processes to ensure accurate and effective workflow distribution.
• Develops applications as defined in requirements and creates deliverables.
• Provides technical expertise of subsystems and any other performance related systems.

Senior Developer

Manager

• Assessing, planning, implementing, coordinating, monitoring, and evaluating comprehensive care plans to meet individual health needs.
• Focus on quality patient outcomes and cost-effective healthcare delivery.
• Provides specialized education and knowledge on disease-specific conditions as needed and assigned.
• Serves as a liaison facilitating a collaborative process with patients, families/caregivers, physicians, and other providers to promote quality of care.

RN Case Manager

• The Licensed Masters Social Work Case Manager will work in the Clinical Services and Population Health area.
• The LMSW Case Manager is responsible for providing support activities for members.
• This includes significant coordination with all departments as well as providers and community based organizations to promote effective, efficient care.