Blue Shield Of California
Business Analyst, Consultant Job at Blue Shield Of California in Rancho Cordova
Blue Shield Of California, Rancho Cordova, CA, United States
Job Description
Your Role
The Provider Dispute Resolution (PDR) team manages and processes provider disputes across the Commercial, Medi-Cal and Medicare lines of business. The team also partners with an offshore vendor to complete provider disputes and other strategic projects. The Business Analyst, Consultant will report to the Director of PDR. In this role you will work closely with the CalPERS product and account management team as well as the Commercial PDR team to develop strategy for the CalPERS product line and Commercial line of business. This role will also convert data obtained from various internal systems into actionable insights to guide business decision making for the PDR and CalPERS teams.
Responsibilities
Your Work
In this role, you will:
Your Knowledge and Experience
The pay range for this role is: $ 96470.00 to $ 144760.00 for California.
Note:
Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.
About the Team
Blue Shield of California's mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.
Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California's top companies in volunteering and giving. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us!
Our Values:
Blue Shield of California is dedicated to making work-life balance a reality. Whether you prefer to work in an office or from home, we understand flexibility is more important than ever. That's why Blue Shield is a hybrid company, offering you the opportunity to decide where you can do your best and most meaningful work.
Two ways of working: Hybrid (our default) and office
Physical Requirements:
Office Environment - roles involving part to full time schedule in Office Environment. Due to the current public health emergency in California, Blue Shield employees are almost all working remotely. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
Please click here for further physical requirement detail.
Equal Employment Opportunity:
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
Your Role
The Provider Dispute Resolution (PDR) team manages and processes provider disputes across the Commercial, Medi-Cal and Medicare lines of business. The team also partners with an offshore vendor to complete provider disputes and other strategic projects. The Business Analyst, Consultant will report to the Director of PDR. In this role you will work closely with the CalPERS product and account management team as well as the Commercial PDR team to develop strategy for the CalPERS product line and Commercial line of business. This role will also convert data obtained from various internal systems into actionable insights to guide business decision making for the PDR and CalPERS teams.
Responsibilities
Your Work
In this role, you will:
- Provide highly complex analytical support through the analysis and interpretation of data in support of cross-functional business operations
- Lead the development of annual operating plans, capital budgets and forecasts, and build business cases for new business initiatives (cost/benefit analysis)
- Develop, prepare, and analyze reports with highly complex analysis and data for management review, and presents to various levels of management
- Define business requirements and provide analysis to increase operational efficiency
- Provide analytical support for multiple, highly complex cross-functional projects simultaneously, establish work plans and timelines, coordinates with internal and external resources
- Coordinate interaction between Data and Analytics teams and business Subject Matter Experts for clarity of requirements definitions
- Use Agile methods to deliver data and reporting solutions
- Present in Operational Committees, trend top drivers of provider disputes, and work with upstream and downstream partners to reduce provider pain points
- Partner with PDR Regulatory Audit Manager and Operations managers in developing new procedures and guidelines for onshore and offshore PDR teams that are aligned with regulatory requirements
Your Knowledge and Experience
- Requires a bachelor's degree or equivalent experience
- Requires at least 7 years of prior relevant experience
- Requires experience validating the quality and integrity of incoming data
- Requires prior experience in data analysis and reporting, including Excel, SQL, BI tools, and data visualization
- Requires excellent communication, presentation, and interpersonal skills, with the ability to communicate complex technical concepts to both technical and non-technical audiences
- Requires expertise in at least one of the following lines of business - Commercial, Medi-Cal and/or Medicare
The pay range for this role is: $ 96470.00 to $ 144760.00 for California.
Note:
Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.
About the Team
Blue Shield of California's mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.
Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California's top companies in volunteering and giving. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us!
Our Values:
- Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
- Human. We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
- Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
Blue Shield of California is dedicated to making work-life balance a reality. Whether you prefer to work in an office or from home, we understand flexibility is more important than ever. That's why Blue Shield is a hybrid company, offering you the opportunity to decide where you can do your best and most meaningful work.
Two ways of working: Hybrid (our default) and office
- Hybrid - In a business unit approved office a few times per year to 3 days per week, on average
- Office - In a business unit approved office 4+ days a week, on average. If the role you're applying for is deemed an "Essential Role," the company has determined that the role can only be performed in a Blue Shield office or in the field and would require your to meet the office worker classification.
Physical Requirements:
Office Environment - roles involving part to full time schedule in Office Environment. Due to the current public health emergency in California, Blue Shield employees are almost all working remotely. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
Please click here for further physical requirement detail.
Equal Employment Opportunity:
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.