Health Care Service Corporation

Underwriter

• Manage a team that underwrites accounts in compliance with HCSC’s goals and objectives and federal and state legislation, resulting in the sale and renewal of group business
• Underwrite and price various funding options and products and make sound decisions
• Apply consortium procedure and pricing where applicable
• Use extensive knowledge of managed care/health care, group insurance products and group health underwriting financial arrangements
• Ensure operational renewal and prospective group health underwriting processes and procedures are followed
• Prioritize and assign work and project assignments and manage team workload
• Develop and deliver presentations to customers and senior management
• Build and maintain positive relationships internally and externally and interact with representatives of large and strategic accounts
• Coordinate initiatives across departments and interact with senior management and lead staff
• Design and lead projects and implement process improvements
• Present to external clients and senior management and interpret BCBS products and competitors' offerings
• Work in a hybrid/flex model with in-office visibility three days per week and remote work two days per week

Underwriting Manager

• Managing a team that underwrites accounts in compliance with HCSC’s goals and objectives as well as federal and state legislation, resulting in the sale and renewal of group business.
• Underwriting and pricing of various funding options and products and making sound decisions.
• Apply consortium procedure and pricing (if applicable).
• Apply managed care/health care, group insurance products and group health underwriting financial arrangements and knowledge of state and federal legislation to underwriting practices and decision-making.
• Prioritizing and assigning work and project assignments.
• Developing presentations, building and maintaining positive relationships internally and externally, interacting with representatives of large and strategic accounts, coordinating initiatives across departments, interacting with senior management.
• Lead staff and coordinate initiatives across departments.
• Designing and leading projects; project management responsibilities.
• Presenting to external clients and senior management.
• Identify and implement process changes; process management and improvement.

Financial Planning and Analysis

• Perform moderate to complex Value Based Care Provider performance financial analyses and special projects
• Prepare all necessary financial analyses, periodic financial statements, and returns and special reports for Provider Financial Performance reviews
• Additional financial and reporting duties as related
• Support HCSC’s mission to expand access to high-quality, cost-effective health care and improve member outcomes

Financial Analyst II

Marketing

• Support Sales Representatives or Account Management Personnel in prospecting, acquiring, or renewing business
• Build relationships with Customer Representatives/Brokers
• Research and coordinate resolution of customer issues
• Prepare and analyze reports
• Participate/lead enrollment meetings
• Gather information for RFPs
• Prepare or implement new accounts or renewals
• Travel to customer sites

Marketing Service Representative – New Business

Actuary

• This position is responsible for participating in implementation, maintenance and more detailed analysis of models, studies and systems which use actuarial principles for the purposes of pricing, underwriting, statistics, reserving, forecasting and other actuarial functions; running and developing complicated models and performing detailed analysis of the results. Developing simple written and oral presentations that provide basic information for decision making. Understanding basic business and actuarial concepts.

Senior Actuarial Analyst

Strategy

• Support leadership by delivering projects related to Pharmacy strategy development, planning, and implementation
• Analyze various data sources (competitive intelligence, internal financials, secondary research)
• Synthesize data in a clear and actionable way and drive projects through to impact
• Frame strategic options and develop recommendations grounded in strategic analysis
• Collaborate on initiatives, develop roadmaps, and create and refine business cases
• Monitor implementation, assess progress, and escalate issues
• Support development/coordination of presentations, communications, planning materials and other strategy-related documents
• Maintain and grow cross-functional relationships, particularly at the leadership level
• Work with leadership to ensure alignment among Enterprise Pharmacy, corporate, and cross-functional priorities

Principal Strategy Consultant – Pharmacy Business

Analyst

• This is a Telecommute (Remote) role. Candidates must live within the following states: IL, IN, IA, KS, MO, MT, NM, NC, OK, PA, TN, TX or WI
• The Claims Analyst is responsible for the accurate adjudication and processing of medical, dental, vision, or other related claims, including related correspondence and/or electronic inquiries for assigned groups.
• All claims and inquiries are handled according to the established plan documents, claim processing guidelines, and established total turnaround times.
• Life & Disability claims: securing and analyzing claim information to make accurate benefit determinations on disability claims or other claim types as assigned, calculate benefit payments and communicate claim decisions, provide responsive and caring customer service.

Claims Analyst

• Lead all aspects of state income tax compliance, reporting, research and planning
• Manage state filing requirements across multiple jurisdictions
• Identify tax savings and planning opportunities
• Monitor nexus exposure and ensure accuracy and timeliness of state filings
• Work within a large health insurance organization (Health Care Service Corporation) to support tax functions

Income Tax Manager

Medical Director

• This position is responsible for planning and implementation of medical policies and programs and strategic involvement with the cost of health care for accounts with more than 800,000 federal employee members across 5 states
• Advising and implementing quality improvement initiatives, medical guidelines, management of high-cost claimants, 2nd level prior authorization and claim reviews and process improvements
• In addition, to various degrees, this position will perform physician level review using applicable systems and maintain effective relationships with physicians, hospitals, and medical service companies to respond to and resolve problems, serving as the final decision maker for clinical determination
• This position will also head projects to promote effective policy relative to the membership of the Federal Employee Program in partnership with the Blue Cross Blue Shield Association

Executive Medical Director – Federal Employee Program

Compliance

• Conduct complex or high risk internal investigations of concerns of misconduct or potential violations of the code of business ethics, conduct and/or company policies
• Prepare detailed summary reports and make recommendations to senior management for corrective action, including disciplinary action up to termination
• Perform investigations and analyses on areas identified as moderate to high risk in the annual risk assessment as well as monitoring corrective action plans for HCSC and subsidiary operations and providing guidance on conflicts of interest and interpretation of company policies
• This position provides mentoring to the Compliance Investigator II position in the absence of the Senior Manager and may assume some duties of the Senior Manager as needed
• NOTE: this role is HYBRID/FLEX and requires in-office visibility three days per week, working from home the other two days
• Relocation is not available and sponsorship will NOT be extended either now or in the future

Lead Compliance Investigator

• Supporting areas technology needs by researching, assisting, and participating in the strategy solutions technology delivery across the enterprise; Managing Day To Day Key Performance Indicators (KPIs) within Salesforce And Other Client Relationship Management (CRM) Tools; Including Recording, Tracking, And Generating Weekly Performance Reports; Interacting With All Levels Of Employees, Especially During Employee Onboarding And In Resolution Of Technology Issues.

Business Technology Analyst

Consultant

• Lead business analysis, ensure alignment and integration across functional areas to support divisional strategies
• Ensure consistency and efficiency of major, complex, and strategic cross-divisional and enterprise-wide projects and initiatives from inception to completion
• Provide oversight & coordination of project teams, resources, and budget to implement projects or initiatives according to dynamic and critical timelines
• Interact with all levels of management including senior management
• Support the prioritization of transformational program activities and track progress to goals

Senior Business Consultant

Manager

• Manage daily activities and implement strategies for provider recruitment and contracting of behavioral health physicians, groups and facilities
• Develop behavioral health strategies, analyze financial impacts, assist/support/lead contract negotiations
• Develop and maintain relationships with providers and ensure strategic coverage for assigned territory
• Provide education and ongoing provider service
• Manage, mentor and train a team responsible for provider contracting and provider support resources
• Provide subject matter expertise to improve efficiencies and results
• Ability and willingness to travel within assigned areas of responsibility, including overnight stays

Manager, Network Management – Behavioral Health

• Provide care coordination to members via telephonic and/or field based care management to inform and educate them on health care programs to address their personal health needs, engage the member in adherence to personal health goals, respond to inquiries from members, and support the clinical operations department with their provider and member activities. This position will be required to complete member telephone and/or field based health screenings, comprehensive health assessments and care planning duties which may require visits to members’ home and/or facilities to support complex and specialty Youth and waiver populations.

Care Manager III

• Provide care coordination to members via telephonic and/or field based care management to inform and educate them on health care programs to address their personal health needs, engage the member in adherence to personal health goals, respond to inquiries from members, and support the clinical operations department with their provider and member activities
• This position will be required to complete member telephone and/or field based health screenings, comprehensive health assessments and care planning duties which may require visits to members’ home and/or facilities to support complex and specialty populations

Behavioral Health Care Manager III - Government Programs

• Perform account management functions from the medical management perspective; serving as primary contact for Sales and Account Management (SAM) Enterprise National, Major/National, Mid-Market Accounts, and Labor specific to presentations for existing and prospective clients, clinical issues and questions on medical management programs.
• Serve as liaison between Marketing and Health Care Management, analyzing and interpreting program performance data in preparation for ASO client meetings, finalist meetings, requests for proposals and recommending program enhancements to Health Care Management Clinical Operations based on client feedback.

Clinical Account Consultant

• This position is responsible to provide care coordination to members via telephonic and/or field based care management to inform and educate them on health care programs to address their personal health needs, engage the member in adherence to personal health goals, respond to inquiries from members, and support the clinical operations department with their provider and member activities
• This position will be required to complete member telephone and/or field based health screenings, comprehensive health assessments and care planning duties which may require visits to members’ home and/or facilities to support complex and specialty populations

Behavioral Health Government Programs Care Manager III

• This position is responsible for monitoring Medicaid and related regulations and policy changes impacting operations; participating in audits; supporting tracking and submission of Medicaid state contract(s) related deliverables, including fulfillment of internal and contractual reporting requirements; working with other areas of the organization on the development, testing and implementation of organization, process and system changes to ensure the requirements of the Medicaid program are met; and assisting MCO in coordination of the contract with the state/CMS enterprise-wide.
• This position will rely heavily on policy writing and SOP documentation creation, review, and/or auditing.

Medicaid Regulatory Analyst

• This position is responsible for managing, developing and maintaining the network strategy for Government Programs, Provider/Vendor Networks; ensuring new and renewed contracts meet enterprise pricing and methodology standards, meet/exceed CMS & or State Network Adequacy requirements.
• This position is responsible for management of direct staff.
• This position is responsible for leading contract negotiations and developing and maintaining relationships with providers/vendors.

Manager, Government Provider Networks

• receipt and coordination of CMS MA-PD and PDP escalated complaints; submission of member and marketing materials to CMS for HCSC’s Medicare Advantage and Prescription Drug Plans; applying CMS regulations pertaining to Medicare Advantage and Prescription Drug Plans to the review of member and marketing materials prior to submission to CMS; providing assistance and guidance regarding Medicare Advantage and Prescription Drug Plan regulations to HISC staff; working with other areas of the organization on the development, testing and implementation of organization, process and system changes to ensure the requirements of the Medicare Advantage and Prescription Drug program are met; and assisting MCO in coordination of the contract with CMS enterprise-wide.

Medicare Regulatory Analyst

Human Resources

• Senior HRBP serves as a strategic thought partner to our leaders embedded in their business priorities, influencing decisions related to organizational design, leadership effectiveness, and talent initiatives
• You will partner with the HRBP Director in gathering appropriate information to respond to the HR needs of the division(s) supported
• Identify opportunities to support business objectives with people implications; and participate in facilitating HR / business related change, and cultural transformation initiatives across assigned business units
• NOTE: This is a hybrid role (3 days on-site per week)
• Relocation is not available, sponsorship will NOT be offered
• Serves as a strategic HR consultant with emphasis in supporting the creation and implementation of the divisions’ Workforce Plans
• Acts as subject matter expert in tools, technologies and methodologies to support business customers; and provides indirect leadership and mentoring of peers
• Exhibits a general knowledge of all areas of HR to include Compensation, Talent Acquisition, Benefits, Workforce Relations, Talent Management, and Learning and Development
• Embeds with client group to maintain strong knowledge of current and future challenges and opportunities
• Proactive to the business needs through directly working with the Centers of Excellence in gathering pertinent information required in supporting the workforce and the HR strategies of the division
• Leverages data to diagnose organizational health and influence decisions around team effectiveness, retention, engagement, and performance
• Identify opportunities in which HR can partner to support business objectives with people implications
• Facilitates cultural transformation and complex transitions, including restructuring, and cross-functional change, ensuring strong change management
• Maintains complete confidentiality of company business and demonstrate strong attention to detail
• Maintains communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested
• Complies with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and all applicable corporate and departmental policies

Underwriting Manager

Underwriting Manager

Financial Analyst II

Marketing Service Representative – New Business

Senior Actuarial Analyst

Principal Strategy Consultant – Pharmacy Business

Claims Analyst

Income Tax Manager

Executive Medical Director – Federal Employee Program

Lead Compliance Investigator

Business Technology Analyst

Senior Business Consultant

Manager, Network Management – Behavioral Health

Care Manager III

Behavioral Health Care Manager III - Government Programs

Clinical Account Consultant

Behavioral Health Government Programs Care Manager III

Medicaid Regulatory Analyst

Manager, Government Provider Networks

Medicare Regulatory Analyst

Senior HR Business Partner