Blue Cross and Blue Shield of Louisiana

Analyst

• Oversee, plan, and implement new and existing healthcare quality improvement initiatives and educational programs that enhance CMS Part C and Part D Star Ratings.
• Manage enterprise‑wide Stars projects from design through completion, ensuring timely delivery and measurable outcomes.
• Serve as a key liaison supporting collaboration across multiple internal departments.
• Lead, plan, and execute Stars performance improvement initiatives across multiple business units.
• Manage and standardize Stars projects, ensuring effectiveness, compliance, and alignment with regulatory and accreditation standards.
• Analyze and interpret complex data sets to identify trends, evaluate program effectiveness, and develop improvement strategies.
• Serve as a subject matter expert, providing thought leadership on measure‑level improvement opportunities.
• Collaborate closely with cross‑functional teams to track KPIs, escalate barriers, and implement innovative quality improvement workflows.
• Build strong internal partnerships, particularly with Health Services and analytics teams, to support clinical workflow enhancements, reporting, and targeting strategies.

Lead STAR Rating Improvement Analyst

Engineer

• Document business requirements and configuration designs
• Execute queries to support metrics, reporting, and analysis
• Provide production and triage support to help resolve system issues
• Assist with ongoing configuration and system support initiatives

CW Configuration Engineer Intern

• Serves as a lead advisor within the Health Quality Department, guiding the design and execution of clinical quality improvement initiatives.
• Supports strategic planning, leads cross-functional project teams, and ensures alignment with regulatory and accreditation standards.
• Lead complex quality improvement projects from concept to completion.
• Mentor and guide Quality Improvement Advisors and Associates.
• Analyze clinical and operational data to identify improvement opportunities.
• Develop and present performance reports to leadership and stakeholders.
• Collaborate with providers and internal teams to drive engagement and performance.
• Ensure compliance with HEDIS, Stars, CMS MIPS, and other clinical measures.

Lead Quality Improvement Analyst

• This position is responsible for completing the activities outlined in the BCBSLA Quality Management Work plan which includes but not limited to working with internal and external representatives to implement, monitor and revise total quality management initiatives, operational procedures and/or performance standards obtain accreditation and achieve strategic goals.
• Analyzes validity of QM data/reports from a clinical perspective.
• Support URAC accreditation activities and Quality improvement activities ensuring on-going accreditation for the Organization.
• Performs accurate concurrent and retrospective review, as needed to support performance improvement activities in conjunction with the goals and strategic plan.
• Assists in performance measurement activities for both providers and the organization (HEDIS, CAHPS and performance measures) at the Plan level, the state level, the BCBS Association level and/or other national initiatives adopted by the Organization to achieve strategic goals.
• Utilizes systematic data collection, aggregation, analysis and reporting techniques to achieve concurrent compliance review of identified quality/patient safety metrics.
• Assists the Manager and Department Director and collaborates with the Healthcare Innovations team and analysts to compile reports for internal and external consumption.
• Helps quality improvement (QI) manager to plan, design, implement, and maintain quality improvement program(s).
• Assists in internal (BCBSLA employees) and external (membership, community, etc) wellness activities to promote prevention and positive health outcomes of our employees and members. This includes but is not limited to Health Fairs and Gaps in Care programs.
• Works with all areas of the company to assist in the implementation and expansion of pay for performance programs, which includes but is not limited to network management, provider quality performance and payment methodologies that support the Plan’s corporate goals and maximizes the Plan’s competitive position.
• Works with Reimbursement and Network Management departments to support quality measurement goals and provider negotiated contracts with the goal of maintaining a high level of provider satisfaction and impact total cost of care.
• Maintain access to applicable data portals and support review of performance data to identify quality improvement opportunities.
• Serve as representative on organizational committees, work groups, and special projects that impact activities and functions internally and externally assisting in the design of business solutions and achievement of corporate goals.
• Responsible for Organizational service and clinical committees required to meet regulatory guidelines. Reporting on opportunities identified and improvement initiatives proposed or in progress. Provide reports comparing progress with national and/or other benchmarks. May require additional research into quality standards and practices. Pursuit of Lean Six Sigma Green Belt and/or training for Healthcare Quality certification (CPHQ, CPC). Accountable for complying with all laws and regulations and accreditation standards associated with assigned duties and responsibilities.

Senior Healthcare Innovations Analyst

• Provides foundational support for quality improvement activities
• Assists management in coordination of internal department monitoring, auditing, and process improvement recommendations to ensure compliance
• Focuses on data collection, documentation, and support for clinical quality initiatives
• Assist with data entry, validation, and basic analysis
• Support documentation for audits, reports, and accreditation
• Coordinate meetings and logistics for quality improvement projects
• Maintain organized records and databases
• Participate in training and development opportunities

Associate Quality Improvement Analyst

• Independently provides analytics in understanding and improving how health care is valued, utilized and provided.
• Develop analytic attributes that pertain to patient level health utilization/outcome, provider performance measures, risk-adjusted revenue optimization, medical cost management, and behavior attributes on patient/provider engagement.
• In collaboration with other business areas and IT, leads in problem solving, solution development and strategic planning and decision making.
• Accountable for complying with all laws and regulations associated with duties and responsibilities.
• Leads the selection of evaluation/analytics/BI methodologies and communicate recommendations to facilitate problem solving, solution development, decision making and strategic planning.
• Appropriately leverages in-house clinical reporting software and models, Enterprise Data Warehouse (EDW) data sources and non-EDW data sources.
• Independently facilitates business development and documents business problems and develops analytic solutions (i.e. Predictive model, BI solution, or analytic attributes).
• Serves as the analytics advisor to collaborating departments on corporate and cross-functional projects, reports and activities.
• Independently translates business rules into analytical models and works as a liaison among healthcare analytics, Enterprise Information Management (EIM), IT and business areas.
• Performs peer data quality reviews, validating data and process to ensure accuracy, completeness and consistency of department output.
• Independently performs descriptive and analytic studies using advanced analytical/statistical techniques.

Senior Healthcare Informatics Analyst

Claims Specialist

• Accurate processing of claims edits
• Determining primacy for the Coordination of Benefits (COB)
• Adjusting previously paid claims
• Initiating procedures to recover funds on overpaid claims
• Analyzing, investigating, and resolving problem cases
• Executing recovery processes
• Completing special projects