Blue Cross & Blue Shield of Rhode Island
Business Operations Analyst
Blue Cross & Blue Shield of Rhode Island, Providence, Rhode Island, us, 02912
Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, Rhode Island, United States of America
Req #1992Schedule: HybridCompensation: $71,700- $107,700Jump into the new world of health insurance:At Blue Cross & Blue Shield of Rhode Island (BCBSRI), our business is healthcare. But our focus is on improving lives. Be part of a team that is large enough to make a difference but small enough to be innovative. Work in a rapidly changing field. Take a chance to be creative. Move outside the status quo. Shape new ideas with the power of a national brand behind you.Join others who know diversity is strength:We appreciate and celebrate everything that makes us unique: age, national origin, citizenship status, perspectives, experiences, physical or mental disability, military status, race, ethnicity, religion, gender, sexual orientation, gender identity and/or expression. Our diversity strengthens us as an organization and helps us better serve an increasingly diverse Rhode Island population.Why this job matters:Coordinate the operational aspects of operational services as related to accuracy and timeliness of transaction processing, configuration or testing. Maintain and perform processes to monitor the outsourcing service delivery. Communicate and coordinate between user areas and the outsourcing party to minimize issues and increase productivity across all areas. Participate in company-wide operational initiatives and work with users to help define process requirements to deliver the best solution.What you will do:Monitor and oversee the operational areas for outsourced and retained functions.Complete operational and technical functions, completing reviews of changes, deliverables, milestones and solutions produced with multiple strategic outsourced vendors, and resolving any identified issues.Assist with the review of all changes made to operations processing to minimize impact to the end-user. Assess the impact of major system migrations and updates, monitoring the progress of resolution for all system issues impacting claims timeliness and accuracy. Review root cause analysis of system issues and ensure accuracy of all impacted operations processes, interaction with associated vendors.Participate in weekly IT operational change management meetings facilitated by strategic outsourced vendors. Review and validate IT service performance data and other reporting outputs provided by strategic outsourcing delivery teams.Develop, manage, track, and monitor outsourced services as related to contract deliverables including SLA, SLO and KPI measurements.Participate in monthly Outsourced Vendor Leadership meetings and attend vendor governance meetings and maintain compliance with all developed processes.Serve as liaison between internal or external business customers. Serve as an escalation point for users when expectations are not met; identify breakdown in workflows, expedite delivery of services, implement a long-term remediation plan, and work with the user community to help streamline processes and add operational efficiencies.Perform testing on technical and operational incidents, strategic project initiatives or proposed system enhancement requests leveraging standardized governance/technical processes and tools.Serve as subject matter expert during strategic project initiatives on behalf of the commercial market. Provide assistance with project requirements from formation to implementation. Oversee all project deliverables are meeting expectations for the operational area by outsourced vendors.Maintain close working relationship with outsourced vendor delivery teams to support collaboration, integration, and coordination at all operational levels.Support development of cross-tower integration standards, policies, and processes.Assist with ongoing reviews, self-monitoring of enrollment operations processing as it relates to products and associated benefits sold to fully and self-insured groups and individual contracts.Assist in ensuring that all enrollment operations processing workflows implemented meet all internal and external regulations (e.g. HIPAA, BCBSA, CMS, etc.). Assist in creating responses to any internal or external audits and, if necessary, work with the appropriate parties to resolve any negative audit findings.Perform other duties as assigned.What you need to succeed:Bachelor’s Degree in Business Administration or a related field, or equivalent experienceThree to five years in operationsExperience managing vendor relationshipsUnderstanding of health plan operationsProficient in SalesforceUnderstanding of outsourcing and vendor oversight responsibilities and service level agreementsAbility to remain calm and professional in stressful situations with customers and vendorsAdvanced analytical skills, with the ability to interpret and synthesize complex enrollment operations configuration and benefit processingGood business acumen and political savvyKnowledge of business process improvement techniques and strategiesExcellent verbal and written communications skillsGood problem-solving skillsAbility to interface with employees at all levelsAbility to effectively navigate ambiguous situations with limited directionExcellent organizational skills and ability to successfully prioritize multiple tasksAbility to handle multiple priorities/projectsLocation:BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role:Remote:
onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Florida, Georgia, Louisiana, North Carolina, Oklahoma, South Carolina, Texas, Rhode Island, Massachusetts, Connecticut and Virginia.At Blue Cross & Blue Shield of Rhode Island (BCBSRI), diversity and inclusion are central to our core values and strengthen our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity, affirmative action employer. We provide equal opportunities without regard to race, color, religion, gender, age, national origin, disability, veteran status, sexual orientation, genetic information and gender identity or expression.
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Req #1992Schedule: HybridCompensation: $71,700- $107,700Jump into the new world of health insurance:At Blue Cross & Blue Shield of Rhode Island (BCBSRI), our business is healthcare. But our focus is on improving lives. Be part of a team that is large enough to make a difference but small enough to be innovative. Work in a rapidly changing field. Take a chance to be creative. Move outside the status quo. Shape new ideas with the power of a national brand behind you.Join others who know diversity is strength:We appreciate and celebrate everything that makes us unique: age, national origin, citizenship status, perspectives, experiences, physical or mental disability, military status, race, ethnicity, religion, gender, sexual orientation, gender identity and/or expression. Our diversity strengthens us as an organization and helps us better serve an increasingly diverse Rhode Island population.Why this job matters:Coordinate the operational aspects of operational services as related to accuracy and timeliness of transaction processing, configuration or testing. Maintain and perform processes to monitor the outsourcing service delivery. Communicate and coordinate between user areas and the outsourcing party to minimize issues and increase productivity across all areas. Participate in company-wide operational initiatives and work with users to help define process requirements to deliver the best solution.What you will do:Monitor and oversee the operational areas for outsourced and retained functions.Complete operational and technical functions, completing reviews of changes, deliverables, milestones and solutions produced with multiple strategic outsourced vendors, and resolving any identified issues.Assist with the review of all changes made to operations processing to minimize impact to the end-user. Assess the impact of major system migrations and updates, monitoring the progress of resolution for all system issues impacting claims timeliness and accuracy. Review root cause analysis of system issues and ensure accuracy of all impacted operations processes, interaction with associated vendors.Participate in weekly IT operational change management meetings facilitated by strategic outsourced vendors. Review and validate IT service performance data and other reporting outputs provided by strategic outsourcing delivery teams.Develop, manage, track, and monitor outsourced services as related to contract deliverables including SLA, SLO and KPI measurements.Participate in monthly Outsourced Vendor Leadership meetings and attend vendor governance meetings and maintain compliance with all developed processes.Serve as liaison between internal or external business customers. Serve as an escalation point for users when expectations are not met; identify breakdown in workflows, expedite delivery of services, implement a long-term remediation plan, and work with the user community to help streamline processes and add operational efficiencies.Perform testing on technical and operational incidents, strategic project initiatives or proposed system enhancement requests leveraging standardized governance/technical processes and tools.Serve as subject matter expert during strategic project initiatives on behalf of the commercial market. Provide assistance with project requirements from formation to implementation. Oversee all project deliverables are meeting expectations for the operational area by outsourced vendors.Maintain close working relationship with outsourced vendor delivery teams to support collaboration, integration, and coordination at all operational levels.Support development of cross-tower integration standards, policies, and processes.Assist with ongoing reviews, self-monitoring of enrollment operations processing as it relates to products and associated benefits sold to fully and self-insured groups and individual contracts.Assist in ensuring that all enrollment operations processing workflows implemented meet all internal and external regulations (e.g. HIPAA, BCBSA, CMS, etc.). Assist in creating responses to any internal or external audits and, if necessary, work with the appropriate parties to resolve any negative audit findings.Perform other duties as assigned.What you need to succeed:Bachelor’s Degree in Business Administration or a related field, or equivalent experienceThree to five years in operationsExperience managing vendor relationshipsUnderstanding of health plan operationsProficient in SalesforceUnderstanding of outsourcing and vendor oversight responsibilities and service level agreementsAbility to remain calm and professional in stressful situations with customers and vendorsAdvanced analytical skills, with the ability to interpret and synthesize complex enrollment operations configuration and benefit processingGood business acumen and political savvyKnowledge of business process improvement techniques and strategiesExcellent verbal and written communications skillsGood problem-solving skillsAbility to interface with employees at all levelsAbility to effectively navigate ambiguous situations with limited directionExcellent organizational skills and ability to successfully prioritize multiple tasksAbility to handle multiple priorities/projectsLocation:BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role:Remote:
onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Florida, Georgia, Louisiana, North Carolina, Oklahoma, South Carolina, Texas, Rhode Island, Massachusetts, Connecticut and Virginia.At Blue Cross & Blue Shield of Rhode Island (BCBSRI), diversity and inclusion are central to our core values and strengthen our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity, affirmative action employer. We provide equal opportunities without regard to race, color, religion, gender, age, national origin, disability, veteran status, sexual orientation, genetic information and gender identity or expression.
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