Summary
 

Why should you join the BlueCross BlueShield of South Carolina family of companies?

Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Position Purpose:

Accountable for directing all aspects of systems modifications and testing for multiple claims systems, and quality control monitoring.

Description
 

Logistics:

This position is full-time (40 hours/week, 8 hours/day) Monday – Friday working onsite at One Century Plaza – 26 Century Blvd, Suite ST610, Nashville, TN 37214

Work Environment: Fast paced, complex office environment

What You'll Do:

• Accountable for directing the testing of standard systems release modifications and their interface with external systems.

• Provide technical assistance to internal staff and to contract/business associates.

• Evaluate and authorize implementation of systems modifications.

• Maintain contacts and effective relationships with external sources, Prime Contractor, government, providers, etc.

• Participate in systems workgroups as a company representative.

• Ensure internal systems files and tables are maintained according to regulations and claims processing procedures. Communicate changes to affected business units.

• Identify and propose solutions for problems or issues which involve complex systems analysis.

• Direct, motivate and develop staff.

• Prepare and manage budget.

To Qualify for This Position, You'll Need:

• Required Education: Bachelor's degree

• Required Work Experience: 10 years of experience including 6 years of systems testing and analysis and either 4 years of management experience OR 4 years of equivalent military experience in grade E4 of above.

Required Skills and Abilities:

• Excellent management, communication, analytical and human relations skills.

• Knowledge of provider reimbursement methodologies.

• Knowledge of budget planning, preparation, and monitoring.

• Strong presentation, organization, customer service, and negotiation skills.

• Computer systems support knowledge.

• Ability to use complex mathematical calculations or statistical concepts.

Required Software and Tools:

• Standard Office Equipment

Required Licenses and Certificate:

• Based on contractual requirements, this position may be classified as a Sensitivity Level 3C Security Risk according to the CMS core security requirements. Level 3C is the highest personnel security level and is subject to periodic criminal background re-investigation checks.

We Prefer You to Have:

• Project Management Certification

• Knowledge of VMS Medicare Claims System

• Workflow knowledge (onbase)

• IVR

• Portal applications