Claims Vendor Integration Analyst

Blue Cross Blue Shield of Massachusetts•Hingham, MA

3d•$90,000 - $110,000•Hybrid

About The Position

This role supports Vendor Integration initiatives to ensure performance goals and standards are met. Working collaboratively with internal and external organizations, the role provides IT- focused project management and operational implementation support to ensure accumulations processing efficiency and appropriate risk management. The position performs analytical, technical consultative and project management tasks for all levels of leadership, departmentally and corporately, as well as production teams to support the implementation of mandates, corporate and Association initiatives, new vendor integration connections, and the resolution of moderately complex business and system challenges. The role also supports analytical and project administration tasks to establish appropriate business requirements, post- production validation, and organizational readiness activities for moderately complex Vendor Integration projects. This position is eligible for the Flex persona.

Requirements

BA/BS degree in business, healthcare or related experience
3-5 years of analytical, process improvement, or audit experience with claims processing and/or vendor integration required.
Excellent verbal and written communication skills; strong business writing skills required.
Demonstrated meeting facilitation and requirement solicitation skills (required)
Proficiency in Microsoft office, specifically MS Outlook, MS Excel, MS Word required.
Strong understanding of BCBSMA core processing systems (OLB, NASCO and RTMS) required.
Proficiency with identifying and drafting business requirements required.
Demonstrated experience in building tools to track and manage open issues to develop Technical and or operational corrective action plans required.
Experience with planning, coordinating, and performing post-production validation required.
Demonstrated the ability to self-learn new tools and processes (required)
Ability to work both independently and in a matrix environment required.
High school degree or equivalent required unless otherwise noted above

Nice To Haves

MS Visio, MS Power Point, and AMS experience strongly preferred.
Understanding of vendor integration and vendor integration tools (Accum Connect, EAVR, MAX, MAT) strongly preferred.
Data Warehouse reporting experience strongly preferred.
Knowledge of BCBSMA’s JIRA and CSR process is strongly preferred.
Understanding of the Defect Management process is strongly preferred.
Previous experience in reconciling account and member data using corporate source systems (Data Warehouse, NASCO, RTMS, etc.) preferred.

Responsibilities

Lead project implementations in the Vendor Integration space and provide expertise in relation to BCBSMA and vendor systems and processes to ensure impact to Vendor Integration is identified and managed.
Accountable for documenting business requirements, business design specifications, creation and coordination of production support for projects
Support team with analysis, scheduling, and reports of RFRs, CSRs and system modifications affecting Vendor Integration and provide quantification for cost benefit analysis and prioritization.
Monitor Vendor Integration metrics and lead cross organizational workgroups to ensure seamless exchange and management of member accumulations.
Monitor vendor performance against agreed upon standards/expectations document variance, and collaborate with the vendors on determining and implementing improvements.
Perform and document root cause. analysis of accumulation exchange and production issues, identify source of issues, quantify impacts, and develop recommendations resulting in cost and/or time savings.
Lead automation opportunities with QA team and other corporate business areas as needed.
Provide guidance and oversight to the QA team on the development of the test plans, test execution, defect management, and user acceptance strategies for the projects and initiatives.
Provide effective communication of project activities to internal and external constituents.
Collaborate with the IT delivery and business teams on project deployment and post-production validation activities.
Support technology upgrades/implementations with project management and workflow documentation.
Provide increased level of oversight and consulting services to Vendor Integration and Claims leaders in a partnership environment on emergent technology options, business process workflows to optimize processing efficiency and performance.
Represent Vendor Integration in cross-functional corporate workgroups and collaboratively develop innovative and effective methods to identify and address ongoing performance and other BCBSMA initiative- related processing and operational needs.
Coordinate technology and implementation requirements representing Vendor Integration with other divisions and project areas across the corporation.
Perform qualitative and quantitative analysis and program and project management tasks as required.