Business Analyst CSC Job:
Blue Cross and Blue Shield of Minnesota

20021-en_US
Blue Cross and Blue Shield of Minnesota
Eagan Minnesota
Healthcare
Description

About Blue Cross



For more than 80 years, Blue Cross and Blue Shield of Minnesota has worked to improve the health of all Minnesotans. As a nonprofit organization, we have a long history of making a healthy difference in people’s lives and of giving back to the communities we serve. In particular, our industry-leading commitment to veterans, service members and their families helped us to be named the first and only Beyond the Yellow Ribbon health plan company in Minnesota.



We make it easy for you to support veterans groups and other community organizations by providing 20 hours of volunteer paid time off each year — in addition to regular paid time off. The dedication of Blue Cross volunteers has earned us recognition for running one of the most successful corporate food drives in the state; donating nearly 1,500 volunteer hours at Habitat for Humanity worksites; and growing more than 750 pounds of fresh produce at our onsite Community Giving Gardens. Find your place at a company that cares about veterans, our employees, our members and our communities.


Description Summary

This position performs analysis, research and information reporting relative to the operational and regulatory performance of the Consumer Service Center. This position also serves as a subject matter expert for regulatory requirements regarding appeals.

Accountabilities


  1. Maintain specialized and comprehensive appeals tracking system of all appeals and grievances received within the department.

  2.  Develop and generate reports for operational needs and regulatory agencies in addition to identify emerging trends and to implement solutions

  3. Conduct in-depth research and analysis on data and processes to identify trends and emerging issues, and recommend best practices for maximum performance.

  4. Actively participates in or facilitates work groups or committees impacting CSC.

  5. Participate in work groups or committees impacting CSC.

  6. May lead or organize projects as assigned.

  7. Review, interpret and analyze changes in regulations, health plan operations and benefit design, implement changes as necessary for CSC to remain compliant.

  8. Participate in internal and external audits and quality assurance process.

  9. Respond to written regulatory and senior staff inquiries, as needed.

  10. Develop training materials and provide training for staff.


Requirements


  • Bachelor’s degree and 3 years experience in the health care and/or health insurance industry or 7 years experience in the health care and/or health insurance industry in lieu of a degree.

  • Extensive knowledge of regulatory requirements for complaints, appeals and grievances and an understanding of the variety of health plan products.

  • Demonstrated strong organizational skills with the ability to manage priorities. 

  • Demonstrated ability to research, analyze, problem solve and resolve complex issues as evidenced by maintaining high quality standards with minimal or no supervision/oversight.

  • Excellent verbal and written communication skills with the ability to express complex concepts in lay terms.

  • Ability to write clear, concise and grammatically correct materials to explain rationale for the decision making process or health plan design concepts.

  • Demonstrated project management skills.

  • Strong facilitation and presentation skills.

  • Demonstrated ability to work independently and in a team environment.

  • Proficient with multiple PC based software applications and systems.

  • Adaptable and flexible with the ability to meet deadlines.

  • Demonstrated initiative and ability to learn and present new concepts, and possession of problem-solving skills.


Preferred Requirements


  • 3 years experience as Liaison I with one year as a Liaison II preferred.


FLSA Status

Exempt

Blue Cross Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, or any other legally protected characteristic.



 



Make a difference



Thank you for your interest in Blue Cross. Be part of a company that lets you be you — and make a healthy difference in people’s lives every day



Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, or any other legally protected characteristic.



Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association

Basic Qualifications
Requirement