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Description

This position is located in Mounds View

Summary:

To coordinate the information management system for the an Affiliate Company in Wellness & Prevention. This print and electronic information resource collection has the capacity to provide responses to information needs such as on-line literature searches and internal library facilitation from staff, Minnesota residents, and national requests.

Accountabilities:

1. Coordinates information services requests.

2. Coordinates internal library functions, to include cataloging, journal subscriptions, ordering materials, routing, shelving, filing, etc.

3. Conducts information research, leveraging content in common topic areas that will benefit the organization and its projects.

4. Identifies new information technologies to streamline access, retrieval, storage and dissemination of information in multiple formats.

5. Provides assistance and coordination on joint projects with federal agencies, public health organizations, and/or libraries both locally and nationally.

6. Participates in preparation and submittal of proposals.

7. Manages all aspects of the production of all assigned newsletters and publications.

Qualifications

Required Qualifications:

1.
Graduate degree in library science, and 5 years library experience.

2.
Knowledge and experience using databases, library networks and the Internet.

3.
Strong communication (oral and written) skills, as well as strong editing skills.

4.
Demonstrated ability to direct and conduct information research that will leverage content in common topic areas to the benefit of our Affiliate Company and its projects.

5.
Ability to coordinate all aspects of print and electronic resource production.

6.
Ability to write content for publications for dissemination in hard copy and/or for addition to Web sites and to oversee content development and design when appropriate for various Web sites.

7.
Ability to design and conduct training specific to subject content and/or information technology.

BlueCross BlueShield of MN is an Equal Opportunity and Affirmative Action Employer, M/F/D/V.BlueCross BlueShield of MN is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Mounds View
Shift: Day Job

Job Level: Experienced Professional]]>http://careers.bluecrossmn.com/job/Mounds-View-Information-Services-Coordinator-for-an-affiliate-company-Job-MN-55112/1863581/186358118635812012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSMounds View, MN, US
Description

Summary:

This position is responsible for providing leadership, planning, strategic direction, and delivery for a product line within a commercial markets segment or line of business (including Health and Wellness) or affiliated companies. The goals and results will align with their portfolio manager's overall segment goals in order to achieve enrollment, revenue and profit performance and business results. This person will be responsible for working with the key internal teams (including sales, underwriting, actuarial, operations, channel, marketing communications, finance, IT, etc) to drive the product plan development and delivery. This will include, but not be limited to, driving market insights, product lifecycle management, market planning, performance monitoring, pricing, and strategic integration.

Accountabilities:

1. Leads the strategy and delivery for a product line within a commercial markets segment. Develops the strategies, plans, and tactics to drive profitable customer acquisition and retention which align with their portfolio manager's overall segment goals to achieve enrollment, revenue and profit performance and business goals.

2. Advances an integrated approach to identification and resolution of market trends in collaboration with Sales, Market Research, Marketing Communications, Customer Experience and other functional areas. Drives the discovery and validation of market problems and opportunities (both existing and future customers) and translates these to opportunities for the product line - re-stages, new offerings, or new niche markets.

3. Directs the product line lifecycle management and is responsible for the successful delivery, including re-stages, new offerings, and retirement of existing products, to meet the overall needs of the market and achieve the business and financial objectives.

4. Leads the planning and execution with the integrated business design teams and the technical product managers to ensure that the product lines continue to evolve to create market differentiation and are executed in a seamless manner with operations and technical teams.

5. Monitors and evaluates the product line performance including market share, profitability, growth, customer feedback and competitive insights.

6. Advances strategies that support the overall segment plan, sector plan and corporate initiatives including health improvement, lowering healthcare costs and increasing individual engagement.

7. Provides leadership to shape the work of their product line steering teams to support the overall segment goals ( these teams in include sales, channel, marketing, research, underwriting and operations)

8. Maintains close relationships with the market (through customers, brokers, agents, and consultants,) to inform opportunity areas. This includes identification of enhanced customer segment insights target (their unmet needs, and strategies to address these needs) and implications for the product lines.

9. Determines opportunities and strategies to buy/build/partner decisions to advance the overall product line.

Qualifications

Required Qualifications:

1.
Bachelor's degree and a minimum of 7 years work experience in the healthcare, sales, marketing, sales operations or related field. In lieu of degree, must have at least 11 years of healthcare, sales, marketing, sales operations experience

2.
3 years experience managing complex projects involving multiple team members and including task assignment, working with key customers (internal or external), managing teams and customer relationships and managing project deliverables.

3.

Strong strategic thinking, analytical, innovation, financial and decision making skills.

4.

Exceptional written and verbal communication skills; proven ability to communicate and collaborate with multiple audiences (internally - various levels of management; externally - healthcare professional, business people, and consumers).

5.

Proven experience in developing and executing winning product plans to deliver corporate objectives.

6.

Skilled at managing products through stage gate development process.

7.

Ability to drive results in a complex, often ambiguous, environment.

8.

Proven experience in managing products in a highly regulated environment while meeting overall corporate objectives.

9.

Self-directed, ability to manage multiple tasks and projects in a timely manner.

10.

Self- directed to expand industry best practices to extend to BCBSMN.

Overnight travel is required infrequently.

Preferred Qualifications:

1. Product management discipline expertise preferred (ex. Pragmatic Marketing)
2.
Experience with health and wellness programs

Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. Blue Cross and Blue Shield of Minnesota is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Eagan
Shift: Day Job]]>http://careers.bluecrossmn.com/job/Eagan-Principal-Product-Consultant-Job-MN-55120/1523064/152306415230642012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Job Summary:

This position is responsible for managing and leading clinical review activities on a clinician team for appeals; ensuring high quality care management and adherence to regulatory, business and compliance standards are met for the commercial and government programs lines of business.

Accountabilities:

1. Manages and leads the over all activities of the clinician review team for appeals which includes day to day operations, evaluating work flows and efficiencies, and makes necessary changes to meet goals and objectives, and process improvements. Ensures processes are in place to meet regulatory and contractual requirements for handling appeals for both the commercial and government lines of business.
2. Interviews and hires employees. Conducts performance evaluations. Coaches, mentors and holds staff accountable to assure department and performance objectives are met.
3. Monitors and reports on production indicators to identify emerging trends and to ensure compliance with department objectives and regulatory requirements.
4. Facilitates the Corporate Appeals Committee.
5. Ensures consistency in processes and functions across the team through auditing and solid business practices.
6. Assures compliance with regulatory and accreditation requirements, contract agreements, and performance guarantees. Participates in regulatory audits and on site reviews as needed.
7. Provides recommendations, modifications and/or develops training materials and workflows.
8. Participates in work-groups/committees in support of core and strategic projects that affect business workflow requirements, processes and objectives.
9. Establishes and maintains strong, positive working relationships, both internal and external to CSC, critical to the success of the department.
10. Collaborates with leadership and staff on planning and providing input on decision-making processes to ensure that departmental, team and individual goals and objectives are met.

Qualifications

Required Qualifications:

- Current RN licensure in the state of Minnesota without restrictions or pending restrictions.
- 7 years of relevant direct clinical care or managed care experience.
- Previous experience in care management and/ or appeals preferably in a health plan.
- 3 years management experience required, which may include progression as a team lead, charge nurse or project manager.
- Demonstrated knowledge of regulatory requirements for complaints, appeals and grievances.
- Critical thinking skills with proven ability to identify and implement process improvements including data collection and analysis, process mapping and root cause identification
- Excellent research, analytical and problem solving skills.
- Strong facilitation skills.
- Effective verbal and written communication skills.
- Demonstrated ability in managing, communicating and meeting time lines and performance metrics.

Preferred Qualifications:

- Bachelor's degree preferred.
- 5 years of management experience

Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. Blue Cross and Blue Shield of Minnesota is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Eagan
Shift: Day Job]]>http://careers.bluecrossmn.com/job/Eagan-Manager-CSC-Clinician-Review-Job-MN-55120/1657412/165741216574122012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Job Summary:

This position will be responsible for providing technical leadership for Data integration and ETL (Extract, Transform and Load) development for the Enterprise Data Warehouse, data submission and other data integration applications for the enterprise data management organization. This senior lead will collaborate and partner with business areas, project teams, IT technical teams and outsourced vendors to ensure high quality application development for data integration initiatives and services focusing on new development for medium project work.

Accountabilities:

1. Lead project initiatives to define scope and implement data integration architecture. Coordinate with business areas, IT cross-divisional technical resources and external customers regarding system scope, objectives and solutions.

2. Lead responsibility as a technical expert in design, development, coding, testing, and debugging new data integration, application, and development. Responsible for making significant enhancements to existing applications. Collaborates with project managers in developing project plans, schedules, status reporting, and issue/risk management.

3. Coordinates and participate in project estimate, development and implementing recommended architecture approaches. Interfaces with Engineering, DBA and Operations departments ensuring application performance, capacity, and that SLA's are developed and met.

4. Reviews and approves design specifications and performs code reviews.

5. Keeps updated with and enforces the data integration development standards and best practices for design, coding, migration and scheduling.

Qualifications

Required Qualifications:

- Bachelors degree in Computer Science or related field and minimum of 4 years of related experience developing complex Data Integration/ETL applications using Informatica Power Center for Teradata, DB2/UDB, or Oracle. In lieu of degree, requires 8 yrs. experience.
- Strong knowledge and understanding of the standard and best practices for Data integration development practice, work estimation, performing design review, and code review.
- Working knowledge on data warehousing methodology, data design, data modeling (3 Normal Form and Star Schema) and SQL knowledge for Teradata, DB2/UDB, or Oracle.
- Experience and working knowledge for UNIX (AIX and Solaris), shell scripting and scheduler (CA7 or others, Informatica scheduling).
- Demonstrated history of collaboration skills with multiple teams (Data analysis, modeling, testing, DBAs, project managers, business areas etc.) for project execution and issue resolution.
- Communicate complex technical information to non-technical audiences including executives, peers and internal and external vendors and business areas and customers.
- Excellent team player. Experienced working with team with with diverse cultural and professional background.

Preferred Qualifications:

- Informatica certification is a plus.
- Certifications related to data warehousing, SQL is a plus.
- Experience and working knowledge with mainframe (COBOL, JCL, IMS, mainframe DB2) is a plus.

Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action Employer, M/F/D/V.

Blue Cross and Blue Shield of Minnesota is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

J2W:DIC

Primary Location: United States-Minnesota-Eagan
Shift: Day Job]]>http://careers.bluecrossmn.com/job/Eagan-Data-Integration-Lead-Sr-Job-MN-55120/1702940/170294017029402012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Summary:

This position will work with leadership and with a cross functional team to drive the development of the business design required to advance significant corporate or product initiatives. The incumbent will ensure the design meets existing and emerging market, purchaser, provider and member requirements. The incumbent will drive the resolution of complex business issues, shape emerging business opportunities and requirements and help the business effectively manage change. Incumbent will be required to lead large virtual teams across the organization and drive for results within tight deadlines. The incumbent serves as the liaison between commercial markets and the operations/IT implementation teams.

Accountabilities:

1. Develop and document consumer requirements, market requirements and business design required to support new products and services. Manage the development of both business solutions and application solutions, focusing on both the business implications of technology and the technology on the business.

2. Drive business decision making process to ensure capabilities, systems and processes meet market expectations and that alternate approaches are vetted and explored

3. Drive business process change and readiness

4. Drive the internal and external communications plan

5. Work with cross functional teams to ensure implementation and migration plans are successfully implemented

6. Coordinate resource needs from commercial markets for key projects

7. Collaborate with business stakeholders to facilitate the analysis and development of cost benefit quantification.

Qualifications

Required Qualifications:

1. Bachelor's degree in Business or related field and five years of project management, process design, customer experience design or consulting experience. In lieu of a degree, must have nine years of project management, process design, customer experience design or consulting experience

2. Demonstrated organizational relationship management skills.

3. Strong creative problem solving skills, conflict resolution, facilitation and negotiation skills, adapting approach as needed

4. Excellent written and verbal communication skills.

5. Self-motivated, ability to work independently, and demonstrated ability to work under tight timeframes.

6. Strong personal computing skills with emphasis on Word, PowerPoint, Excel and MS Project

7. Proven ability to handle a variety of assignments in a fast paced and complex business environment

8. Strong knowledge of the health care industry, payer business models, business segments and products

9. Proven ability to define problems, collect and analyze data, establish facts and draw valid conclusions

Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. Blue Cross and Blue Shield of Minnesota is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Eagan
Shift: Day Job]]>http://careers.bluecrossmn.com/job/Eagan-Business-Design-Consultant-Principal-Job-MN-55120/1763896/176389617638962012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Summary:

This position is responsible for carrying out critical implementation and maintenance efforts for the Affiliate Company's clients for the compliance program. Some of these efforts include facilitation of communication, compliance training and program monitoring and auditing. This position is responsible for validating compliance with Medicare and other Federal and State legal and regulatory requirements across all functions of the Affiliate Company's client base. The validation coordination and facilitation of regulatory audits and other regulatory communications as required by government contracts. This position entails close collaboration with staff of Affiliate Company, Affiliate Company clients and Government entities.

Accountabilities:

1. Directs and collaborates with affiliate company leadership team to create a Compliance Program and Compliance Support functions that meet client and state and federal requirements with the Centers for Medicare & Medicaid services (CMS).
2. Assist clients Compliance Officers in staffing of Compliance activities and audit committee, lead plan meetings and participate in Subcommittee based on contractual commitments.
3. Directs the department including interviewing and hiring employees following required EEO and Affirmative Action guidelines and ensuring employees receive the proper training. Conducts performance evaluation, and is responsible for managing employees, including skill and career development, policy administration, coaching on performance management and behavior, employee relations and cost control.
4.
Direct the implementation and maintenance of the compliance and operational policies and procedures as determined in client contracts

5. Serve as a resource for Affiliate Company, Affiliate Company's clients and vendors to ensure that they and their employees have the requisite level of information and knowledge of applicable regulatory issues and requirements.
6. Work with Affiliate Company, Affiliate Company's clients and vendors to establish appropriate reporting to ensure effective, proactive monitoring. Develop cross functional coordination of compliance activities through regular reporting to the appropriate committees, leadership or governing bodies.
7. Coordinate external regulatory audits of programs managed by Affiliate Company. Coordinate the responses to audit findings, ensure the implementation of responses, and monitoring of corrective action plans as needed.
8. Direct the completion of audits of First Tier, Downstream and Related Entities. This may include pre delegation assessments of new vendors.
9. Direct the filing of forms, reports and marketing materials to CMS to ensure requirements are met. Work closely with Affiliate Company, Affiliate Company's clients and vendors to ensure that there is a clear process established to obtain and submit documents that require submission to CMS.
10. Develop and maintain productive working relationships with all Affiliate Company staff, Affiliate Company's clients and CMS.
11. Develop and maintain an effective management and line staff that is capable of consistently responding to business requirements. Fosters a positive and rewarding work environment for employees. Ensure adherence to corporate Human Resource policies and CMS requirements.
12. Participate in Affiliate Company's business development work groups for the development of services that will provide revenue generation of Affiliate Company.

Qualifications

Required Qualifications:

- Accepting this director level position at BCBSMN requires signing an Agreement Regarding Non-Disclosure of Confidential Information and Non-Competition as a condition of employment.
- Bachelors Degree with 10 years experience in healthcare industry and/or Medicare experience.
- 7 years of management experience.
- Broad knowledge of the health insurance industry compliance and specific knowledge of state and federal health insurance laws and regulations.
- Knowledge of Health Plan operations including claims, enrollment, sales and marketing, health services, membership, appeals and grievances.
- Proven experience in the development and implementation of corporate regulatory compliance and ethics program.
- Proven managerial and group process skills including cross-functional team development in a matrixed environment.
- Ability to work independently , to make sound business decisions and handle a variety of challenges and responsibilities.
- Previous planning and project management experience.

Preferred Qualifications:

- Master's degree in business or policy preferred but not required.

Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. Blue Cross and Blue Shield of Minnesota is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Eagan
Shift: Day Job]]>http://careers.bluecrossmn.com/job/Eagan-Director-Compliance-for-Affiliate-Company-Northern-Plans-Alliance-Compliance-Officer-Job-MN-55120/1763901/176390117639012012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Summary:

The purpose of this position is to develop, implement, and provide compliance support activities to Affiliate Company clients that participate in government programs. This position is responsible for managing the activities associated with Affiliate Company client compliance activities including CMC, vendors and Health Plan interactions. This position is responsible for fulfilling contractual commitments supports clients compliance programs including but not limited to : oversight activities with operations teams, communicating regulatory requirements and monitoring Affiliate Company and vendor compliance with new (applicable) state and federal legislation. In addition, this person will assist in carrying out the compliance assessment goals, work schedules, assessment activity, and reporting, development of compliance related training programs and participation in audit work based on contractual expectations.

Accountabilities:

1. Establish and maintain a positive working relationship with CMS/DHS/OIG and other regulatory agencies and industry leaders to identify regulatory issues that impact the Medicare/Medicaid business.

2. Develop processes and reports to oversee and monitor the client activities to ensure compliance with CMS and contractual requirements.

3. Work with CMC vendors, clients and Plans to educate, train, implement self monitoring, audit and corrective action plans.

4. Establish and maintain a comprehensive understanding of all new and existing laws, regulations and other requirements that impact our products and operations in order to provide guidance to analysts on contract language filings and implementation and other compliance strategies.

5. Manage the identification, interpretation, education and implementation of Medicare Modernization Act, Medicare Managed Care Manual and CMS Monitoring Guide requirements. Review cross functional Polices and Procedures across the enterprise to ensure adherence to compliance requirements.

6. Coordinate with any internal audit functions to ensure CMS required audits are completed according to regulatory requirements using assessment tools and corrective action plans.

7. Develop and implement audit plans, self monitoring and audit tools to monitor and track compliance.

Qualifications

Required Qualifications:

- Bachelor's degree and 5 years experience in the health care industry with specific ethics/compliance program knowledge and experience in Medicare and Medicaid Programs required.
- 3 years experience managing project(s) involving multiple team members and including task assignment, working with key customers (internal or external), managing team and customer relationships and managing project deliverables.
- Detailed knowledge of the U.S. Sentencing Guidelines, the development of Government Programs Compliance Plans, Medicare Advantage and Medicaid Products.
- Proven ability to work with CMS/State Regulators.
- Knowledge of Health Plan operations including claims, enrollment, sales and marketing, health services and membership.
- Fundamental knowledge of health insurance regulation at both federal and state levels
- Proven experience in the development and implementation of corporate regulatory compliance and ethics programs.
- Demonstrated success in a leadership position.
- Significant training experience including program development and implementation.
- Well-developed analytical, problem-solving and communication skills. Business Analysis expertise and ability to translate regulatory requirements into operation.
- In depth understanding and experience in application development and submission to the Federal Government on Medicare Products, Advanced understanding of Part D regulatory requirement.

Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. Blue Cross and Blue Shield of Minnesota is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Eagan
Shift: Day Job]]>http://careers.bluecrossmn.com/job/Eagan-Compliance-Manager-for-Affiliate-Company-Job-MN-55120/1765926/176592617659262012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Summary:

This position manages people, processes, work plans and deliverables of Affiliate Company and interfaces with affiliate company's clients. Acts as "Subject Matter Experts" for Medicare and Medicaid claims platform(s) and other systems, processing and business needs for government business. Serves as business lead for affiliate company's claims activities as described in contractual commitments. Ensures that business requirements as they pertain to claims processing for all products (including Medicare and Medicaid) are turned into accurate technical requirements and communicated to appropriate participants in claims migration projects and consulting services. Further, this position will be responsible for significant interfaces with project teams from a client and vendors. This position will provide direction and documentation to supports work products are appropriately translated into business requirement and tangible business solutions.

Accountabilities:

1. Directs and/or consults on the analysis of business needs for system development or enhancements to clients chosen operating systems according to business, market and regulatory requirements. Additionally, provides direction and recommendations to clients work plan on operating systems business needs as the claims system migration or implementation is underway.

2. Development of communication and implementation plans as they relate to the Claims project to meet Clients regulatory and/or business needs.

3. Directs and/or consults with staff and cross-functional teams, Vendors in process analysis, modeling, system and interfaces analysis and information flows.

4. Collaborates with internal staff and external clients of system needs and translates business requirements to Client and Vendors and is the lead in regard to translating Clients business and regulatory needs.

5. Ensures business continuity of business needs across Clients product needs.

6. Manages the department including interviewing and hiring employees following required EEO and Affirmative Action guidelines and ensuring employees receive the proper training. Conducts performance evaluation, and is responsible for managing employees, including skill and career development, policy administration, coaching on performance management and behavior, employee relations and cost control.

Qualifications

Required Qualifications:

- Bachelor's degree in Business Management or other related field.

- 3 years managerial experience in Medicare or Medicaid.

- 7 years experience in translating regulatory requirements into business needs.

- Demonstrated ability to effectively organize, direct and planning in an operational role for government business.

- Familiar with both the Medicare and Medicaid regulatory framework as it pertains to the payment for services under the Federal Medicare programs (including but not limited to Medicare Advantage) and the Federal and state Medicaid programs and the corresponding coverage rules and payment guidance.

- Experience related to the processing of Medicare and Medicaid claims.

- Ability to matrix manage and leadership skills.

- Proven record of staff management and staff development.

- Experienced in project management.

- Experience in managing Client expectations

- Experience with large system platform transformations.

- Strong oral and written skills.

Some travel required

Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. Blue Cross and Blue Shield of Minnesota is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Eagan
Shift: Day Job]]>http://careers.bluecrossmn.com/job/Eagan-Manager-Government-Programs-Claim-Migration-for-Affiliate-Company-Job-MN-55120/1765927/176592717659272012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Summary:

The Dedicated Nurse/Clinician is a critical component of Blue Cross Blue Shield of MN's Integrated Health Management team. The position exists to support member needs across the continuum of care by leveraging member partnership, case management and disease management processes, skill sets and tools.

Accountabilities:

1. Receives referral and/or reaches-out to member and leverages clinical knowledge, motivational interviewing and behavioral modification techniques.
2. Conducts comprehensive clinical assessments; Gathers, analyzes, synthesizes and prioritizes member needs and opportunities.
3. Collaborates and communicates with the health care team; e.g. member, family, designated representative, health care provider on a plan of care that produces positive clinical results and promotes high-quality, cost effective outcomes.
4. Identifies relevant Blue Cross Blue Shield of MN and community resources and facilitates warm program and network referrals.
5. Monitors and evaluates plan of care over time.
6. Ensures member data is documented according to Blue Cross Blue Shield of MN application protocol and regulatory standards.
7. Maintains outstanding level of service at all points of customer contact.
8. Understands broad-based goals of assigned market segment(s).
9. Collaborates and coordinates with team members to facilitate day to day functions and enhance the overall operation of the department.

Qualifications

Required Qualifications:

1. Registered nurse with current MN license or LSW with no restrictions 3-5 years relevant clinical experience
2. Outstanding communication skills
3. Outstanding conceptual thinking skills
4. Outstanding relationship management skills
5. Computer application proficiency
6. Flexibility to work varied hours

Preferred Qualifications:

1. If not currently CCM, then eligible to prepare for CCM after 2 years in position, and obtain CCM within 4 years of hire
2. 1+ years of managed care experience; e.g. case management, utilization management and/or auditing experience
3. Outstanding telephonic skills

Blue Cross Blue Shield of MN is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. BlueCross BlueShield of MN is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Eagan
Shift: Day Job

Job Level: Experienced Professional]]>http://careers.bluecrossmn.com/job/Eagan-Dedicated-Nurse-Clinician-Commercial-Job-MN-55120/1767924/176792417679242012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Job Summary:

Blue Cross continues to expand its Enterprise Data Warehouse. We are looking for several well qualified Data Architects to join our Data Management team to lead data warehouse and data integration projects working with our BI, ETL and QA team members and business partners. The EDW was recently moved to a new Teradata platform to support additional business areas and integrate with a multi-year initiative to re-source and integrate claims, member and client data from external partners. It will also be a key point of integration for upcoming MDM and Marketing initiatives that support health care reform.

Accountabilities:

1. Lead or oversee all aspects of the data management lifecycle from gathering business requirements, creating logical and physical data models, analyzing and mapping data, producing and applying DDL to performance tuning.

2. Design normalized structures for OLTP systems in Oracle or DB2 and base tables in Teradata

3. Create the semantic layer creating high performance views and data marts that support departmental initiatives.

4. Partner with Solution Architects, Application Developers, ETL, QA, and DBA to architect and build high quality data and analytic solutions.

5. Become an expert on one or more domains of health care information and work directly with business users or analysts to improve data quality and understanding.

6. Ensure creation of accurate and timely business, technical and process metadata.

7. Optimize designs for the Teradata platform or improve our development and data management processes.

8. Create best practice standards and mentor colleagues to use them effectively with agile development approaches.

9. Conduct individual tactical and team task planning and estimating.

10. Work independently, exercise leadership and take advantage of the ready support of the professional, team oriented data management group.

Qualifications

Required Qualifications:

- Bachelor's degree in Computer Science, or degree in physical or social sciences, philosophy, language or related discipline with technical experience, and 5 years experience with Data Modeling or Data Warehouse Design, or 9 years of experience with Data Modeling or Data Warehouse Design, in lieu of a degree.
- Experience with Database Design or Physical Data Modeling
- General knowledge of SQL and DDL
- Experience with Business Requirements and Analysis
- Experience with data profiling and mapping

Preferred Qualifications:

- Query Performance Tuning
- Designing views, data marts and semantic layers
- Development or Application DBA knowledge
- Experience with Teradata
- Experience in Healthcare or Insurance
- Experience building high performance user semantic layers
- Knowledge of BI environment and tools, especially SAS
- Knowledge of ETL or ELT, especially Informatica or Teradata
- Mentoring Skills in data modeling & architecture
- Demonstrated ability to influence and motivate individuals and teams
- Advanced presentation skills with strong oral and written communication skills

Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. Blue Cross and Blue Shield of Minnesota is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

J2W:DIC

Primary Location: United States-Minnesota-Eagan
Shift: Day Job]]>http://careers.bluecrossmn.com/job/Eagan-Data-Architect-Job-MN-55120/1773997/177399717739972012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Summary:

This person provides counsel, planning, project management and development in support of winning and retaining clients. Strong organizational and interpersonal skills are required to successfully manage multiple projects and integrate efforts with other department throughout the company, while working closely with sales and account management partners. Responsibilities include writing and editing sophisticated responses to complex requests for proposal and other information and content relevant to business needs.

Accountabilities:

1. Collaborates with business partners to develop comprehensive and strategic responses to requests for proposals (RFPs), requests for information (RFIs), and other customer requests.
2. Serves as project manager and strategic content leader for assigned proposal projects. Identifies barriers and uses problem-solving skills to keep projects on track.
3. Researches, develops, writes and edits complex content for internal and external audiences using subject matter experts and other resources as needed.
4. Serves as content expert in developing and maintaining database responses to assigned products, processes or services.
5. Manages business partner relationships for assigned projects; serves as a member of various sales and marketing efforts; represents the department on various internal and external committees and work groups.
6. Evaluates effectiveness of communication strategies and tactics and shares results. Participates in quality improvement efforts. Identifies better means to serve business partners.
7. Other projects (e.g., writing, editing, managing) as assigned.

Qualifications

Required Qualifications:

- Bachelors degree in communications, marketing or journalism and a minimum of five years of related health plan experience.
- Strong research, problem-solving and analytical skills.
- Demonstrated interpersonal skills for working with business partners, vendors and cross-functional teams.
- Excellent project and time management skills for juggling changing priorities and working under tight deadlines and for making formal presentations.
- Highly refined writing skills.
- Demonstrated personal computer skills in the use of a suite of software tools (such as Microsoft Word, PowerPoint and Excel).

Preferred Qualifications:

- Experience with specialized proposal software such as RFP Machine and similar Sant/Kadient tools.

Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. Blue Cross and Blue Shield of Minnesota is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Eagan
Shift: Day Job]]>http://careers.bluecrossmn.com/job/Eagan-Senior-Proposal-Consultant-Job-MN-55120/1775980/177598017759802012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Job Summary:

This position gathers, analyzes and interprets government programs data in order to support the design, development and evaluation of initiatives focused on improved delivery of health care services and outcomes. The position is responsible for obtaining a wide variety of data from various internal and external sources, understanding relevant differences between each data sourced, and using the information for analysis and reporting. This individual works closely with coworkers to analyze and use data for improved decision making. This individual participates in workgroups providing expertise and data analysis to support key divisional initiatives and strategies. Projects often involved significant work with other divisions, requiring a high level of expertise in developing and maintaining strong business relationships.

Accountabilities:

1. Gather and analyze quantitative and qualitative data and conduct literature reviews.
2. Use data to identify and prioritize quality improvement opportunities, recommend QI programs/projects (member, provider, community, policy, and/or plan
3. Track implementation of selected QI programs/projects. Identify issues and/or barriers and work with colleagues to address those effectively.
4. Coordinate and collaborate cross-departmentally to ensure QI objectives are met.
5. Assist co-workers in using data/information in innovative ways.
6. Communicate trends, opportunities, strategic recommendations, and outcomes to key stakeholders.

Qualifications

Required Qualifications:

- Bachelor's degree in social/health sciences or related field and 5+ year's experience working on or leading health care and/or public health improvement projects. In lieu of degree, must have 9+ years experience working on or leading health care and/or public health improvement projects.
- Demonstrated project management skills.
- Problem solving/analytic skills and experience.
- Ability to analyze data and transform into project-level strategies.
- Strong verbal, written, and presentation skills.

Preferred Qualifications:

- Knowledge of regulatory and accreditation requirements preferred.
Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. Blue Cross and Blue Shield of Minnesota is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Eagan
Shift: Day Job]]>http://careers.bluecrossmn.com/job/Eagan-Government-Programs-QI-Project-Manager-Job-MN-55120/1790069/179006917900692012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Summary:

This position has accountability for client retention and growth, margin contribution and overall business performance of the the Key Accounts segment. The Director develops the segment business plan and oversees reporting of key indicators to ensure business plan objectives are met and we are able to forecast and adjust actions as needed to meet corporate market segment goals. Accountabilities include client business planning and strategy development, and cross-functional execution of the client business plan. This position also leads organizational development of the account management practice along with deployment of industry best practices for technology, process and human resource strategies. This position represents programs and services within the Blue Cross and Affiliates product/service portfolio. The director is also responsible for working directly with Marketing, Underwriting and Operations to ensure product, pricing and services meet the needs of the Key Accounts segment. This position enhances corporate level relationships between the Blue Cross organization and key fortune 500 companies in Minnesota. Each client company under management is run via a formal approved business plan. Loss of any one of these clients can result in failure to meet market segment growth and revenue goals as well as market reputation loss.

Accountabilities:

1. Selects, manages, coaches and motivates sales and account management team members.

2. Active performance management of staff to maintain a high performance team.

3. Create, deploy and run an effective organizational structure and processes within account management and across Blue Cross functional organizations to deliver a model for account management that becomes known for creating customer loyalty.

4. Direct staff development and lead change management initiatives to align staff competencies and performance with industry best practice. Drive processes that will ensure superior knowledge level of staff on emerging industry trends and skills in account management practices.

5. Direct the development and execution of account business plans that identify an annual strategy to achieve retention, ancillary corporate growth, margin and budget objectives.

6. Serve as a driver and advocate with Underwriting, Product Management, and Operations to communicate market needs and issues to ensure that Blue Cross maintains its market leader position

7. Participate in the development of new products and assist in refining current products and pricing offerings. This includes strategic development efforts around defining market requirements, pricing expectations, competitive landscape, staff training, and client adoption expectations.

8. Develop and enhance corporate level relationships with clients and industry leaders through regular direct interaction and oversight of a corporate executive contact plan.

9. Manages the department including interviewing and hiring employees following required EEO and Affirmative Action guidelines and ensures employees receive the proper training. Conducts performance evaluation, and is responsible for managing employees, including skill and career development, policy administration, discipline, employee relations and cost control.

Qualifications

Required Qualifications:

- Accepting this director level position at BCBSMN requires signing an Agreement Regarding Non-Disclosure of Confidential Information and Non-Competition as a condition of employment.
- Bachelor's degree in a related field, and 7 years of experience in the industry, or 11 years of related work experience with 3 years of sales experience in lieu of a degree
- 5 years experience in a sales leadership position (staff management)
- Expert strategic planning and business planning skills.
- Demonstrated personnel and change management skills to motivate and lead a highly skilled professional staff, including demonstrated coaching, performance management, and organizational skills.
- Superior oral, written and interpersonal persuasive communications skills with the ability to work and negotiate with key contacts at all levels of an organization both internally and externally.
- Demonstrated ability to lead, drive results and excel in a collaborative environment.
- Proven ability to exercise good judgment and make decisions in the face of ambiguity and within tight timeframes.
- Ability to build and maintain strong positive business relationships at all levels within Blue Cross and in the industry.
- Ability to gain influence, credibility and respect.
- Ability to navigate through a complex, matrixed organization and operate successfully in an environment with high level of ambiguity.
- Advanced knowledge of health care environment, local and national competition, leading edge products and account management strategies, competitive drivers and best practices design.
-
Currently possess or will acquire a Minnesota health and life license within 9 months of starting in this role.

Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. Blue Cross and Blue Shield of Minnesota is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Eagan
Shift: Day Job]]>http://careers.bluecrossmn.com/job/Eagan-Director-Account-Management-Key-Accounts-Job-MN-55120/1794844/179484417948442012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Summary:

The UM Specialist is a critical component of BCBSM's Integrated Health Management team. Generally, the position exists to promote appropriate, effective and efficient use of health care resources via pre- and post-service review, appeals and program and network referrals. The scope of this position includes medical and surgical care and treatment.

Accountabilities:

1. Applies clinical experience, health plan benefit structure and claims payment knowledge to pre- and post-service reviews.

2. Gathers relevant clinical data through multiple sources.

3. Leverages clinical knowledge, business rules, regulatory guidelines and policies and procedures to determine clinical appropriateness.

4. Ensures that members have access to care across the network

5. Serves as a utilization management resource and shares expertise across market segments, department and division; e.g. partners with Dedicated Nurses and Behavioral Health Dedicated Clinicians.

6. Analyzes utilization management trends.

7. Coordinates with members and providers via multiple communication tools; e.g. phone, fax, letter.

8. Maintains outstanding level of service at all points of customer contact.

9. Demonstrates the behaviors inherent to the "Find a Way" culture; e.g. continuous learning, innovation to facilitate day to day accountabilities and enhance the overall performance of the department.

Qualifications

Required Qualifications:

- Registered nurse with current MN license with no restrictions
- 1+ years relevant clinical experience
- Outstanding communication skills
- Outstanding analytical thinking skills
- Outstanding task facilitation skills
- Computer application proficiency

Preferred Qualifications:

- 1+ years of managed care experience; e.g. case management, utilization management and/or auditing experience
- 3-5 years of RN experience
- International Classification of Diseases (ICD-9) knowledge and Current Procedural Terminology (CPT) coding experience
- Outstanding telephonic skills

Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. Blue Cross and Blue Shield of Minnesota is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Eagan
Shift: Day Job]]>http://careers.bluecrossmn.com/job/Eagan-Medical-UM-Specialist-CSC-Job-MN-55120/1806701/180670118067012012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Job Summary:

Install, maintain, and provide 24x7 system support for UNIX system software and hardware with the primary focus on IBM AIX and Oracle Sun. Technical Engineer Senior role will analyze and evaluate customer requirements characterized by technical and analytical requirements. Strong collaboration with Security Administrators, Middleware Administrators, Capacity Planning & Monitoring, Service Desk, and Network Administrators when designing and implementing computer systems utilizing "state of the art" concepts, techniques and languages. Responsible for planning, developing, testing and documenting computer systems and follow up to ensure success of the UNIX environment.

Key Accountabilities:

1. Administer the Unix AIX and Oracle / Sun infrastructure.
2. Build and configure AIX servers on big iron, large scale environment running multiple LPAR's.
3. Apply scheduled AIX and Solaris software maintenance.
4. Install and maintain various ISV products from EMC, CA, and others.
5. Manage migrations from older hardware / software to new.
6. Upgrade firmware during scheduled maintenance windows
7. Identify, automate, and script repeatable processes.
8. Maintain disaster recovery warm site environment.
9. Coordinate with vendor to replace failed hardware.
10. Create and update team documentation.
11. Participate in 24x7 on-call support rotation.

Qualifications

Required Qualifications:

1. Power 6 or 7 hardware experience
2. Solaris 8 or 9 or10 experience
3. AIX virtualization experience in a dual VIO configuration
4. Experience with NIM, HMC, NPIV, vSCSI, and SEA
5. Bachelor's degree in Computer Science, Mathematics, or related field and 3 years of experience to include leading UNIX activities, or 7 years of experience in lieu of a degree.

Preferred Qualifications:

1. IBM Systems Director experience
2. Experience with EMC VMAX and Powerpath
3. Experience using Veritas Volume Manager in a large SAN environment
4. Experience using Solaris Disk Suite / Volume Manager
5. Experience using Perl
6. Demonstrated ability to work independently
7. Demonstrated ability to communicate effectively and collaborate to all levels of the IT organization and correctly identify the needs of customers.

Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action Employer, M/F/D/V.

Blue Cross and Blue Shield of Minnesota is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

J2W:DIC

Primary Location: United States-Minnesota-Eagan
Shift: Day Job]]>http://careers.bluecrossmn.com/job/Eagan-Technical-Engineer-Senior-Job-MN-55120/1808788/180878818087882012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Summary:

This position is responsible for providing development support in the writing, budgeting, and submission of grant and consulting proposals to third-party entities for two Blue Cross affiliate companies. This position is also responsible for collecting, analyzing, and reporting data on the performance of program activities that are funded by third-party public and private sources.

Accountabilities:

Prepares consulting proposals and grant applications.

Responsible for professional and administrative work in researching, identifying, developing and responding to business opportunities in the areas of policy, system and environmental changes that supports healthy environment, and the prevention and treatment of chronic disease.

Generates proposals and supporting documents in responses to formal and informal solicitations

Generates revenue for affiliate companies through timely submission of well written and well-documented grant/consulting proposals.

Maintains and implements funding calendar activities, including cultivation activities.

Assists in the writing of reports to government, corporate, foundations and other funders/clients.

Acts as liaison with development, consulting, sales, and contracting staff.

Conducts prospecting and identifies funding opportunities and new program areas to match company or client priorities.

Supports Sales Team to solicit invitations to submit proposals.

Works with finance/contract management/consultants to gather information necessary to meet reporting requirements, and achieving profitable contracts.

Qualifications

Required Qualifications:

5 years of grant writing and/or program development experience.

Bachelors degree in Public Health or other health science, business, health promotion or related field or in lieu of degree 9 years of grant/proposal writing or program development experience.

Strong written communication skills; ability to write clear, structured, articulate, and persuasive proposals for diverse clientele

Knowledge of diverse funding sources.

Strong editing skills.

Attention to detail.

Preferred Qualifications:

Government and/or health care experience

BlueCross BlueShield of MN is an Equal Opportunity and Affirmative Action Employer, M/F/D/V.BlueCross BlueShield of MN is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Eagan
Shift: Day Job

Job Level: Experienced Professional]]>http://careers.bluecrossmn.com/job/Eagan-Grant-Proposal-Consultant-Sr-Job-MN-55120/1808789/180878918087892012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Summary:

Performing as a regional representative for the operations center, this position is responsible for coordinating and leading the planning, development, administration and execution of specific projects. This position drives continuous improvement through streamlining existing methodologies to heighten service satisfaction and promote client retention.

Accountabilities:

1.Determines the specific business needs and objectives of a project. This includes determining how they relate to the corporate strategic plan and developing strategies to ensure projects contribute to the achievement of these plans. Documents new business process flow charts and descriptions, human resource and information technology needs, performance measurements, implementation and transitional plans of completed efforts.

2. Develops and articulates auditing standards to ensure consistency. Formulates appropriate action plans aimed at creating total quality service delivery to clients.

3. Responsible for project management and administration, including scheduling, resource allocation and implementation.

4. Facilitates cross-functional interfaces and impact on all impacted organizations, which includes cultural concerns and barriers. Facilitates presentations to internal and external audiences on various subject matters critical to successful and innovative service advancement.

5. Responsible for recruiting, training, and educating team members, company personnel and/or consulting personnel to promote innovative thinking and questioning of established practices. Responsible for unifying team members into productive, self-directed work groups.

6. Conducts benchmarking activities including research and summary activities.

7. Assists in developing a communications plan to support the implementation of the project/process.

Qualifications

Required Qualifications:

Bachelors degree in Business or related field and 5 years of project management experience; or equivalent training, education and/or experience.

Knowledge of project management principles and methodologies.

Broad knowledge of operational processes.

Proven ability to deliver presentations to diverse audiences.

Knowledge of benchmarking activities and processes.

Knowledge of process improvement strategies and mechanisms.

Strong oral and written communication skills.

Proven ability to foster positive cross-functional relationships.

Advanced quantitative and qualitative analytical ability to use data interpretation.Proven administrative skills including planning, organizing, time management and delegating and the ability to articulate these skills to staff.

BlueCross BlueShield of MN is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. BlueCross BlueShield of MN is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Eagan
Shift: Day Job]]>http://careers.bluecrossmn.com/job/Eagan-Operation-Consultant-Sr-Job-MN-55120/1816049/181604918160492012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Job Summary:

Install, maintain, and provide 24x7 system support for Linux system software and hardware with the primary focus on zVM. Technical Engineer Senior role will analyze and evaluate customer requirements characterized by technical and analytical requirements. Strong collaboration with Security Administrators, Middleware Administrators, Capacity Planning & Monitoring, Service Desk, and Network Administrators when designing and implementing computer systems utilizing "state of the art" concepts, techniques and languages. Responsible for planning, developing, testing and documenting computer systems and follow up to ensure success of the Linux zVM environment.

Key Accountabilities:

1. Administer the Linux zVM mainframe infrastructure.
2. Build and configure Linux servers on the mainframe running multiple LPAR's.
3. Apply scheduled Linux and zVM software maintenance.
4. Install and maintain various ISV products from EMC, CA, and others.
5. Manage migrations from older hardware / software to new.
6. Identify, automate, and script repeatable processes.
7. Maintain disaster recovery warm site environment.
8. Create and update team documentation.
9. Participate in 24x7 on-call support rotation.

Qualifications

Required Qualifications:

1.
zVM experience

2.
SUSE SLES 10, 11 experience

3.
Bachelor's degree in Computer Science, Mathematics, or related field and 3 years of experience to include leading UNIX activities, or 7 years of experience in lieu of a degree.

4.
Ability to troubleshoot zLinux OS issues

5.
Experience maintaining zVM network architecture, including VSWITCH and OSA networks

6.
Experience with zVM Performance Toolkit

Preferred Qualifications:

1.
IBM Systems Director experience

2.
Experience writing REXX code

3.
Experience upgrading OS from SUSE SLES10 to SUSE SLES11

4.
Experience with Linux on Intel

5.
Demonstrated ability to work independently

6.
Demonstrated ability to communicate effectively and collaborate to all levels of the IT organization and correctly identify the needs of customers.

Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action Employer, M/F/D/V.

Blue Cross and Blue Shield of Minnesota is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

J2W:DIC

Primary Location: United States-Minnesota-Eagan
Shift: Day Job]]>http://careers.bluecrossmn.com/job/Eagan-Technical-Engineer-Senior-Job-MN-55120/1816050/181605018160502012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Job Summary:

The Senior Test Analyst is responsible for the Data Warehouse and BI Applications Quality Assurance to include: test coordination, test analysis, test planning, design and test execution for the ETL loads and extracts as well as testing for data submissions and data marts.

This role requires people and personal initiative leadership skills to oversee and provide small team directions to the offsite resources on some projects and the ability to define the testing approach using risk analysis.

Accountabilities:

1. Leads or participates with management in planning the testing activities for projects, including testing scope, artifacts, timelines, and reviews.
2. Creates test strategy and test plan documents for small to medium size projects that will encompass end-to-end testing.
3. Leads test activities for small to medium size projects.
4. Capable of overseeing and coordinating a small group of testers (1-3). Ensures collaboration with analyses and development teams
5. Coordinates scheduling for system and integration testing, and communicates with testing partners where there are multiple systems and application development teams involved.
6. Creates a Requirements Validation Matrix (RVM), ensuring all requirements are unambiguous, testable, verifiable and complete.
7. Defines test environment and test data approach.
8. Creates test scenarios and test cases. Propose and implement test automation approach.
9. Analyzes test results and documents defects and issues, including root cause, using the Defect Management Process.
10. Assesses defect impact to the business and proposes workarounds, where appropriate.
11. Participates in the process of generating metrics related to application quality.

Qualifications

Required Qualifications:

1. Bachelor's degree in Computer Science, Business Administration or related topic and 4 years of test analyst experience in information services, to include 2 years in a test lead role with small teams. In lieu of degree, 8 years of test analyst experience in an information services, to include 2 years in a test lead role with small teams.
2. We require strong leadership skills within small teams and proven ability to demonstrate "personal leadership initiative" in performing one's individual job responsibilities, rather than waiting to be told what next steps need to be taken.
3. Solid understanding of databases and SQL experience in working with flat files with record types.
4. Basic UNIX knowledge
5. Basic XML knowledge
6. Demonstrated ability to influence and motivate individuals and teams
7.

This job requires to be onsite and available for face-to-face meetings between the hours of 8am and 4pm or 9am and 5pm. Monday through Friday.

Preferred Qualifications:

1. SAS Tool experience
2. Experience with IBM Rational Tools
3. Some development experience.
4. Data warehouse background is preferred but not necessary. Data warehouse practices will be developed over time (2-3 months).

Blue Cross and Blue Shield of Minnesota is a Equal Opportunity and Affirmative Action Employer, M/F/D/V.

Blue Cross and Blue Shield of Minnesota is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

J2W:DIC

Primary Location: United States-Minnesota-Eagan
Shift: Day Job

Job Level: Experienced Professional]]>http://careers.bluecrossmn.com/job/Eagan-Test-Analyst-Senior-Job-MN-55120/1816051/181605118160512012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Summary:

This position provides management to the Consumer Service Center appeals staff for government business; to facilitate the ability of the staff to achieve their goals, meet regulatory and compliance requirements and strengthen their skills and knowledge of the organization. This position supports the needs of the appeals staff by ensuring they have the proper systems, support, ongoing learning and development opportunities as well as a positive working environment. This position is responsible for facilitating appeals and grievance handling to meet objectives of timeliness, thoroughness, consistency, and compliance requirements. Identify appeals trends and opportunities for production and process improvement.

Accountabilities:

1. Manages a team of liaisons who are responsible for handling appeals and grievances for government business. Responsible for performance management, skills and career development, and employee relations. Interview, hire employees and conduct performance evaluations.

2. Monitors and reports on production and quality indicators to identify emerging trends and to ensure compliance with department objectives and regulatory requirements for handling appeals and grievances.

3. Facilitates Corporate Appeals Committee, project and team meetings.

4. Supports both internal and external audits.

5. Develops and provides recommendations for training materials.

6. Participates in internal work-groups/committees in support of core and strategic initiatives that affect business processes.

7. Establishes and maintains strong working relationships, both internal and external to CSC, critical to the success of the department. Facilitates communication with direct reports, peers, and business partners.

8. Identifies, supports and leads process improvement initiatives.

9. Provides resource support to liaisons handling appeals and grievances.

10. Provides appeals operations reporting.

11. Ensures the staff is advised of changes in business rules, regulatory requirements, and workflow processes that impact their work.

Qualifications

Required Qualifications:

- Bachelor's degree and 5 years experience in healthcare industry with at least 3 years in a supervisory capacity, or nine years of relevant business experience in the healthcare industry in lieu of a degree.

- Demonstrated knowledge and understanding of regulatory requirements for complaints, appeals and grievances.

- Demonstrated quality improvement skills including data collection and analysis, process mapping and root cause identification.

- Demonstrated strong organization skills.

- Excellent research, analytical and problem solving skills.

- Excellent communication skills and demonstrated ability to develop accurate and appropriate communications and reports.

- Proven ability to work independently and in a team environment. Demonstrated ability to coach and mentor others.

- Strong facilitation skills.

- Strong written and oral communication skills.

Preferred Qualifications:

- Demonstrated knowledge and experience working with Minnesota and CMS regulations for appeals and grievances.

BlueCross BlueShield of MN is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. BlueCross BlueShield of MN is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Eagan
Shift: Day Job

Job Level: Manager]]>http://careers.bluecrossmn.com/job/Eagan-Manager-Consumer-Service-Center-Government-Appeals-&-Grievances-Job-MN-55120/1818004/181800418180042012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

**- This position is located in Washington, DC. No relocation assistance provided **-
Summary:

This position is responsible for the sale, retention, and growth of Affiliate company, consulting services and products, within the government market, foundations, and non-profit integrated delivery network health systems. This new for-profit consulting company is part of BCBSM's revenue diversification efforts, and will have high visibility among Affiliate company as well as other affiliate companies. This position is responsible developing strong professional relationships within their target markets, fill their sales pipeline, shorten the sales cycle, and maximize the yield on their discovered opportunities. Post-sale involvement in the engagement will provide some oversight of the assigned consultants in order to assure their satisfaction with the work provided, and to seek out additional and ongoing consulting work. The position will have to work closely with the public health consultants, presales/grant writers, contracting staff, and finance.

Accountabilities:

1. Build and maintain relationships with key stakeholders and customers locally and nationally, including federal agencies, state and local health departments, and state and national community health and prevention experts. Develop and implement new sales strategies for these markets that create a sales pipeline creating new business for Affiliate companies. Considerable focus will be on building a robust sales pipeline, shortening the sales cycle, and maximizing the yield of potential prospects, with the ultimate goal of achieved an assigned sales quota.

2. Collaborate with internal and external business partners to execute market plans and modify them as market input dictates. Identify new services, monitor current services, and identify improvement opportunities, resource needs and solutions.

3. Manages all sales leads and follow up conversations once an opportunity is identified.

4. Maintain adequate pipeline records regarding sales activities.

5. Prepares and monitors project proposals and project plans to determine time frame, procedures for accomplishing project, staffing requirements, and allotment of resources to various phases of project.

6. Post-sale, directs and coordinates individual projects and related activities of consultants deployed in the field to ensure that the project progresses on schedule and on budget, delivers services per customer expectations and contractual terms, and results in profitable growth of the company.

7. Leads cross-functional and cross-divisional teams to forge result-oriented processes that respond to the needs of the business units, both individually and collectively, where appropriate, by analyzing opportunities, implementing changes in existing processes and incorporating new processes, systems or designs.

8. Represent Affiliate company in local and national forums of health leaders.

Qualifications

Required Qualifications:

- Bachelors' degree and 5 years of work experience in the public health or prevention field and 2 years of in-the-field consulting experience, or 11 years of work experience in public health or prevention field required in lieu of a degree and 2 years of in-the-field consulting experience.
- Exhibit strong ability to lead and work effectively with cross-functional teams and demonstrate problem solving and creative solution development with a strong sense of urgency. Must be self-motivated with strong initiative to learn.
- Fundamental knowledge of public health concepts, and organizational structure and funding sources at both the municipal, state and federal levels.
- Strong communication skills (both verbal and written).
- Strong emphasis on the ability to build collaborative relationships.
- Ability to work independently.
- Demonstrated intermediate to advance knowledge of Microsoft Word and Excel .
- Ability to organize, prioritize and delegate appropriate tasks.
- Experience influencing the sale of services, programs and concepts
- Travel, up to 50% overnight depending on market territory.
- Strong presentation and training skills.

Preferred Qualifications:

- Located in Washington, D.C.
- Three of years Federal funding experience either as a sales executive, or purchaser
- Health & Wellness experience
- Industry sales experience with state and local agencies, and within the commercial and health plan markets
- Demonstrated basic knowledge of SalesForce.com

Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. Blue Cross and Blue Shield of Minnesota is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Eagan
Shift: Day Job]]>http://careers.bluecrossmn.com/job/Eagan-Sales-Executive-for-Affiliate-Company-%28Washington%2C-DC%29-Job-MN-55120/1820467/182046718204672012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Job Summary

The SAP Technical Lead provides technical and business direction for SAP solutions. Provides technical direction and assistance to other developers, as well as guidance to management regarding SAP technical direction and best practices/standards.

Accountabilities:

1. Work with SAP Functional Support Group to define business/functional requirements, and research/document technical specifications.
2. Develop solutions using SAP programming tools and methods (ABAP code, ABAP Web Dynpro, Portal, Workflow, ALV's, ALE-IDOC's, BAPI's, LSMW's, SAP Script, SMART Forms, Adobe Forms. Research, apply and test SAP (OSS) Notes).
3. Develop and maintain standards for SAP technical coding processes that are in adherence to SAP standards. Ensure that SAP technical activities (e.g. ABAP/Java development) maximize the use and adoption of standard SAP.
4. Provide guidance and direction for day-to-day development tasks within the SAP Development staff.
5. Provide resource and time estimates.
6. Work with IT managers and business reps to identify, recommend, design and implement solutions.
7. Help the business understand SAP. Provide SAP best practice guidance and solutions to business and functional users.

Qualifications

Required Qualifications:

1. Seven years of SAP experience with at least one year in a lead technical role.
2. Possesses and uses expert level skills in the following areas Enterprise Resource Management Systems, particularly SAP, Java, ABAP/4, C, SAP Forms, Adobe Forms, Report Writer, EDI, Portal, Workflow, IDoc.
3. Strong knowledge and experience in ALE, EDI, IDOCs, RFCs, BAPIs, SAP Workflow (Configuration and Development), Portal, SAPscripts , Smartforms, Adobe Forms, BDC, LSMW, ABAP Web Dynpro, ABAP Reporting, Data Dictionary, Screen Painter, Menu Painter, applying user exits, ABAP query & report writer tools
4. Strong knowledge and experience in designing and troubleshooting interfaces between SAP and external systems
5. Action oriented. Strong analytical and problem solving skills; experience in both process and solution analysis and design
6. Strong teamwork and interpersonal skills

Preferred Qualifications:

1. MBA/MS degree or equivalent is preferred.
2. Understanding of SAP Basis - knowledge and experience in this area would be an advantage.
3. Good understanding and knowledge of SAP's Netweaver platform, SAP Exchange Infrastructure (XI), SAP Business Warehouse and Database Skills would be an advantage.

Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. Blue Cross and Blue Shield of Minnesota is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

J2W:DIC

Primary Location: United States-Minnesota-Eagan
Shift: Day Job]]>http://careers.bluecrossmn.com/job/Eagan-SAP-Technical-Lead-Job-MN-55120/1822543/182254318225432012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Summary:

The IHM Clinical Lead is a critical component of Blue Cross and Blue Shield of Minnesota's Health Management team. The position is a blend of providing case review support, mentoring and clinical accountabilities. The IHM Clinical Lead is a subject matter expert as well as a coach. He or she spends up to 50 percent of his or her time supporting employees, coaching them over time and providing performance feedback to the Manager. The IHM Clinical Lead spends up to 50 percent of his or her time managing a case load. He or she partners with the Integrated Health Management Learning and Development (L&D) Team to follow-through on formal L&D interventions to ensure employee learning.

Accountabilities:

1. Provide day to day support for Team members.

2. Mentor, coach and fulfill role of "preceptor" for clinicians.

3. Provide performance feedback to Manager - the Clinical Lead role does not deliver performance management feedback to clinicians; this is the responsibility of the manager.

4. Maintain up to 50% clinical case review accountabilities in order to maintain expertise and experience.

5. Assist with clinician case assignments and consultations, trouble-shoot issues and questions and be the first level escalation for clinicians.

6. Participate in special projects and groups as requested by the Manager.

7. Maintains exceptional level of service at all points of customer and staff contact.

8. Has a working knowledge of broad-based goals, regulations and accreditation requirements of assigned market segment(s).

9. Facilitates the on-boarding process for new employees.

10. Acts as a liaison with the IHM Learning and Development team and Manager with the goals of supporting education and consistency in implementation of policy, procedure and regulatory requirements.

Qualifications

Required Qualifications:

Requirements for all IHM Medical Management Departments:

1. RN with current and unrestricted MN license or licensed Mental Health Professional (see list below)

2. 5 years relevant clinical experience

3. 3 years of managed care experience; e.g. case management, disease management, utilization management

4. Exceptional and demonstrated communication skills

5. Exceptional and demonstrated conceptual thinking skills

6. Exceptional and demonstrated relationship management skills

7. Proficient in PC applications required to support medical management

8. Certified as case manager (CCM) for Case and Disease management positions (not applicable to Healthy Start program)

9. Forward-thinker with exceptional problem solving skills

Additional Requirements:

Per item 1., can be a RN or Licensed for independent practice with one or more of the following:

- Licensed Marriage and Family Practice (LMFT)
- Licensed Independent Clinical Social Worker (LICSW)
- Licensed Psychologist (LP)
- Registered Nurse with psychiatric experience
- Experience working with state and federal regulatory and compliance standards
- Licensed Professional Counselor (LPC) or Licensed Professional Clinical Counselor (LPCC)

BlueCross BlueShield of MN is an Equal Opportunity and Affirmative Action Employer, M/F/D/V.BlueCross BlueShield of MN is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Eagan
Shift: Day Job]]>http://careers.bluecrossmn.com/job/Eagan-IHM-Clinical-Lead-Job-MN-55120/1833196/183319618331962012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Job Summary:

This position has primary accountability for leading the detail design, construction, integration, and implementation of technical deliverables in large, complex application development projects. The position is responsible for working with business areas, project teams, IT technical teams, application and service vendors, and outsourced development partners to achieve project success.

Accountabilities:

1. Works with technical staff to implement complex software solutions involving many varied technologies, components, and platforms.
2. Participates as a technical expert in design, development, coding, and testing of new software or making significant enhancements to existing software.
3. Contributes to conceptual design.
4. Accountable for completing design deliverables, including preparation of detail specifications from which applications will be developed.
5. Assists project managers in developing technology requirements and estimates.
6. Works closely with customers, integration partners and technical team members to design solutions for complex technical integrations and software deliverables.
7. Provides direction to vendor partner software developers.
8. Responsible for the review and acceptance of code deliverables, documentation, and other project artifacts.
9. Accountable for the coordination of code deployments.
10. Accountable for the development of technical documentation for the knowledge transfer of new applications to application support teams.

Qualifications

Required Qualifications:

1. Experience in developing and delivering software projects and solutions utilizing distributed technologies including Websphere, DataPower, Message Broker, Java, SOA services, and Rational tools.
2. Resume must demonstrate distributed programming and team lead experience
3. Bachelor's degree in Management Information Systems or a related field and a minimum of 6 years of software development experience. If no degree, then a minimum of 10 years of software development experience
4. Demonstrated ability to design and develop large complex software solutions.
5. In-depth knowledge of infrastructure components including security, connectivity, database management systems, and EDI.
6. Excellent analysis and problem solving skills.
7. Strong communication, collaboration and leadership skills to effectively interact with upper management, business leaders, peers, and vendors, and for influencing and motivating individuals and teams.

Preferred Qualifications:

1. General knowledge of BCBS business areas.
2. Health Care Industry knowledge
3. Technical Certification
4. Knowledge and understanding of Agile development practices and methodologies.
5. Experience in working with off-shore vendor partners

Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action Employer, M/F/D/V.

Blue Cross and Blue Shield of Minnesota is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

J2W:DIC

Primary Location: United States-Minnesota-Eagan
Shift: Day Job

Job Level: Experienced Professional]]>http://careers.bluecrossmn.com/job/Eagan-Application-Project-Delivery-Tech-Lead-Principal-Job-MN-55120/1835403/183540318354032012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Summary:

This position is responsible for the customer-service strategy for Blue Cross to ensure high quality, cost effective service to our members and providers. Individuals in this position are responsible for developing a service strategy that ensures we are well positioned to compete in a rapidly evolving and competitive environment. The integrated service delivery strategy integrates all aspects of customer and provider interaction including claim administration, contact center and process improvement. Additional accountabilities include oversight of the organizational metrics strategy, Service compliance plan and execution, and sourcing strategies.

Accountabilities:

1. Establishes strategic direction and integrated service delivery to deliver cost effective, claim processing for that meets performance measures and regulatory and HIPAA compliance requirements.
2. Establishes strategic direction, goals and organizational procedures for the Blue Cross contact center to deliver high quality service to members and providers, achievement of performance guarantees and corporate measures.
3. Develops effective strategies for Membership and Billing to ensure timely processing of applications, and accurate, timely and cost effective billing and reconciliation.
4. Develops effective strategies to ensure that benefit setup accurately reflects benefit design, complies with state and federal regulatory requirements, Blue Cross Association mandates and customer expectations.
5. Delivers resource and capacity management strategies to maximize efficiencies including process management, forecasting and scheduling and reporting.
6. Provides leadership and support on cross functional projects by providing strategic insight on industry, regulatory and customer requirements
7. Collaborates across the organization to assure Service strategies are aligned to support achievement of company's business objectives and overarching strategic plan
8. Represents Blue Cross' service organization to employer groups, provider groups and regulatory agencies.
9. Identifies and develops talent within the Division and across the Company, promote diversity and meet AAP/EEO guidelines

Qualifications

Required Qualifications:

Accepting this position at BCBSMN requires signing an Agreement Regarding Non-Disclosure of Confidential Information and Non-Competition as a condition of employment.

- Bachelor's degree in Business or other related field
- 10 years senior leadership experience
- 5 yrs in a health plan or health organization.
- Demonstrated ability to lead and implement strategies to build reputation and communicate effectively with stakeholders.
- Expert strategist to develop and lead strategic and operational plans that deliver outstanding service to customers.
- Demonstrated ability to develop collaborative relationships with key stakeholders within and outside the organization.
- Demonstrated knowledge of Customer Contact tools and technology
- Proven ability to deliver persuasive messages based on sound, thorough, fact based analysis and logic to compel senior leadership to act as needed.
- Proven ability to perform complex business analysis and decision-making (business case development, operational model design, program planning and steering)
- Proven brand management experience; ability to build and manage wellness and prevention company brand image as a corporate, statewide, and national leader.
- Proven record of pertinent accomplishments and expertise
- Demonstrated ability to work cross-functionally with a diverse workforce.

Preferred Qualifications:

- Advanced degree, preferably MBA.

BlueCross BlueShield of MN is an Equal Opportunity and Affirmative Action Employer, M/F/D/V.BlueCross BlueShield of MN is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Eagan
Shift: Day Job

Job Level: Senior Executive]]>http://careers.bluecrossmn.com/job/Eagan-VP-Client-Service-Job-MN-55120/1838860/183886018388602012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Summary:

This position is responsible for the sale, retention, and growth of Affiliate company, consulting services and products, within the government market, foundations, and non-profit integrated delivery network health systems. This new for-profit consulting company is part of BCBSM's revenue diversification efforts, and will have high visibility among Affiliate company as well as other affiliate companies. This position is responsible developing strong professional relationships within their target markets, fill their sales pipeline, shorten the sales cycle, and maximize the yield on their discovered opportunities. Post-sale involvement in the engagement will provide some oversight of the assigned consultants in order to assure their satisfaction with the work provided, and to seek out additional and ongoing consulting work. The position will have to work closely with the public health consultants, presales/grant writers, contracting staff, and finance.

Accountabilities:

1. Build and maintain relationships with key stakeholders and customers locally and nationally, including federal agencies, state and local health departments, and state and national community health and prevention experts. Develop and implement new sales strategies for these markets that create a sales pipeline creating new business for Affiliate companies. Considerable focus will be on building a robust sales pipeline, shortening the sales cycle, and maximizing the yield of potential prospects, with the ultimate goal of achieved an assigned sales quota.

2. Collaborate with internal and external business partners to execute market plans and modify them as market input dictates. Identify new services, monitor current services, and identify improvement opportunities, resource needs and solutions.

3. Manages all sales leads and follow up conversations once an opportunity is identified.

4. Maintain adequate pipeline records regarding sales activities.

5. Prepares and monitors project proposals and project plans to determine time frame, procedures for accomplishing project, staffing requirements, and allotment of resources to various phases of project.

6. Post-sale, directs and coordinates individual projects and related activities of consultants deployed in the field to ensure that the project progresses on schedule and on budget, delivers services per customer expectations and contractual terms, and results in profitable growth of the company.

7. Leads cross-functional and cross-divisional teams to forge result-oriented processes that respond to the needs of the business units, both individually and collectively, where appropriate, by analyzing opportunities, implementing changes in existing processes and incorporating new processes, systems or designs.

8. Represent Affiliate company in local and national forums of health leaders.

Qualifications

Required Qualifications:

- Bachelors' degree and 5 years of work experience in the public health or prevention field and 2 years of in-the-field consulting experience, or 11 years of work experience in public health or prevention field required in lieu of a degree and 2 years of in-the-field consulting experience.
- Exhibit strong ability to lead and work effectively with cross-functional teams and demonstrate problem solving and creative solution development with a strong sense of urgency. Must be self-motivated with strong initiative to learn.
- Fundamental knowledge of public health concepts, and organizational structure and funding sources at both the municipal, state and federal levels.
- Strong communication skills (both verbal and written).
- Strong emphasis on the ability to build collaborative relationships.
- Ability to work independently.
- Demonstrated intermediate to advance knowledge of Microsoft Word and Excel .
- Ability to organize, prioritize and delegate appropriate tasks.
- Experience influencing the sale of services, programs and concepts
- Travel, up to 50% overnight depending on market territory.
- Strong presentation and training skills.

Preferred Qualifications:

- Three of years Federal funding experience either as a sales executive, or purchaser
- Health & Wellness experience
- Industry sales experience with state and local agencies, and within the commercial and health plan markets
- Demonstrated basic knowledge of SalesForce.com
- Experience with tribal nations preferred

Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. Blue Cross and Blue Shield of Minnesota is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Eagan
Shift: Day Job]]>http://careers.bluecrossmn.com/job/Eagan-Sales-Executive-for-Affiliate-Company-Job-MN-55120/1842151/184215118421512012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Job Summary:

The Test Lead role is accountable for all aspects of testing for both development projects and small enhancements. The Test Lead develops a test strategy that identifies the required test approaches (e.g. manual, regression, automated and performance) and the resources (e.g. people, technology, data) to adequately verify that the project or enhancement delivers at the expected quality level. This role oversees the testing efforts on multiple concurrent projects and small enhancements by ensuring that our vendor partners deliver as expected. This role is charged with the oversight of test estimation, test planning, test development, test execution and risk impact analysis. The Test Lead collaborates with the development, security, data and environment teams to ensure testing quality and delivery.

Accountabilities:

1. Leads test activities for multiple small to medium size projects. Capable of overseeing and coordinating a small group of testers (1-5) on any given project. Will have accountability for multiple projects or a single large program.

2. Coordinates scheduling for system and integration testing, and communicates with testing partners where there are multiple systems and application development teams involved

3.Acts as the primary liaison with the business SME during business acceptance testing

4. Creates test strategy and test plan, including reviews of the test plan documents on multiple projects that will encompass end-to-end testing

5. Leads or participates with management in planning the testing activities for projects, including testing scope, artifacts, timelines, and reviews

6. Addresses issues preventing test delivery by our vendor partners6. Assure quality of test documents and metrics

7. Participates in the process of generating metrics related to application quality

8. Assesses defect impact to the business and proposes workarounds, where appropriate

9. Track and monitor project test estimates relative to actual testing hours

Qualifications

Required Qualifications:

1. Bachelor's degree in Computer Science, Business Administration or related topic and 4 years of test related experience in an information services role. In lieu of degree, 8 years of test related experience in an information services role.
2. More than 1 year experience conducting Business Acceptance Testing or User Acceptance Testing
3. 3 plus years related experience in the healthcare field to include claims experience
4. Demonstrate Strong technical knowledge of mainframe, client/server, or web-based environments
5. Demonstrate Strong technical knowledge of testing tools

Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action Employer, M/F/D/V.

Blue Cross and Blue Shield of Minnesotais a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

J2W:DIC

Primary Location: United States-Minnesota-Eagan
Shift: Day Job

Job Level: Experienced Professional]]>http://careers.bluecrossmn.com/job/Eagan-Test-Lead-Senior-Job-MN-55120/1842152/184215218421522012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Job Summary:

The Infrastructure Architect is a centralized role responsible for defining and deigning highly complex solutions to address business and infrastructural needs. Works with project managers, enterprise and solution architects, security, application delivery, application development, management, and infrastructure delivery teams to effectively manage and ensure optimal physical designs, technology solutions, estimates, and delivery.

The Infrastructure Architect designs infrastructure frameworks, proof-of -concepts, standards and reference architectures. Works to apply enterprise-wide set of disciplines for the planning, analysis, design and construction of information systems on an enterprise-wide basis or across a major sector of the enterprise, and works with senior level management to establish strategic computing direction with emphasis on improving efficiency, effectiveness, and stability of the IS Operation computing environment. The Infrastructure Architect also serves as a high level technology expert and a critical resource for problem management activities.

Accountabilities:

1. Defines complex architectural infrastructure solutions to address business needs and architecture designs.
2. Works to design, deploy, and sustain agile, robust and highly available environment.
3. Strong Communication
4. Ability to comprehend rapidly the functions and capabilities of new and existing technologies
5. Conducts detailed analysis and study of requirements for new or existing projects to determine feasibility, cost and time required, compatibility with current systems and hardware capabilities.
6. Develops analytical and computational techniques and methodology for problem solutions.
7. Performs process and data modeling in support of the planning and analysis efforts using both manual and automated tools.
8. Applies reverse engineering and re-engineering disciplines to develop migration strategic and planning documents.
9. Establishes standards, reference architecture, and repeatable build patterns for technology use and design.
10. Provides technical guidance in software engineering techniques and automated support tools.
11. Governs detailed design documents the ensure adherence to Infrastructure Architecture Standards.
12. Leads or contributes to the creation of an architectural framework.
13. Performs technical competitive analysis of vendor solutions and advises leadership

Qualifications

Required Qualifications:

1. Bachelor's degree in Computer Science, Mathematics, or related field and 10+ years of work related experience in a data processing environment, or 14 years of work related experience in lieu of a degree.
2. 8 years experience in information systems development, system analysis and design, program design and documentation preparation, with 5 years experience in a lead technical consulting role.
3. Demonstrated experience in the implementation of information engineering projects; systems analysis, design and programming using standard tools and methods, systems planning, business information planning.
4. Advance to expert level knowledge and understanding of architecture, application design, systems engineering and integration
5. Experience in designing and supporting large mission critical systems
6. Experience leading and influencing without formal authority
7. Effective at driving change
8. Ability to partner with internal and external customers to achieve strategic objectives
9. Demonstrated exceptional written and oral communications skills, including giving formal presentations to different audiences.

Preferred Qualifications:

1. Health Care Experience
2. ITIL Certification(s)

Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action Employer, M/F/D/V.

Blue Cross and Blue Shield of Minnesota is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

J2W:DIC

Primary Location: United States-Minnesota-Eagan
Shift: Day Job

Job Level: Experienced Professional]]>http://careers.bluecrossmn.com/job/Eagan-Technical-Engineering-Architect-Job-MN-55120/1847254/184725418472542012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Job Summary:

Database Administrator role will administer and control data resources; design physical database structures; implement and maintain physical databases; perform tuning/capacity planning for database management system resource usage; and support proper utilization of Oracle database management software and associated products for data and database administration at the customer level. Coordinates physical changes to computer databases; codes, tests, and implements physical database.

Works closely with Application Developers, Data Modelers, Engineering, Security Administrators, Capacity Planning & Monitoring, Service Desk Scheduling and, Network Administrators as needed. Applies business process improvement practices to re-engineer methodologies/principles and business process modernization projects. Assist in establishing standards for information systems procedures. Assists in constructing sound, logical business improvement opportunities consistent with corporate Information Management guiding principles, cost savings, and open system architecture objectives.

Accountabilities:

1. Maintenance of operational databases and the data warehouse, including performance tuning, overseeing backups, and creating scripts for task automation.
2. Participates in designing, building, and configuring databases to the specifications documented in the physical Technical Architecture Design (TAD) documents.
3. Participates in the investigation, analysis and resolution of database problems.
4. Monitors and implements proactive, corrective measures to prevent database problems or shut downs.
5. Follows standard incident, problem, and change management processes.
6. Participates in database management system projects.
7. Reads and understands the logical Software Architectural Design (SAD) and contributes to the creation of the database portion of the Technical Architectural Design (TAD) document.
8. Contributes to the improvement of internal database standards and best practices for schema and database design.
9. Participates in the evaluation and recommendation of new software and hardware database solutions, feasibility studies and vendor comparisons.

Qualifications

Required Qualifications:

1. Bachelor's degree in Computer Science, Mathematics, or related field, and 1 year of experience Oracle database administration, or 5 years of expereince in lieu of a degree.
2. Working knowledge of database design, file access methods, data standards, data control and security.
3. Working knowledge of backup and recovery issues associated with database platforms.
4. Ability to prepare clearly written technical documentation which includes procedures and technical matters.

Preferred Qualifications:

1. Working knowledge of MSSQL, or DB2 database systems and relational database systems in general.
2. Kornshell scripting experience. Experience with PERL scripting is a plus.Demonstrated ability to work independently.
3. Demonstrated ability to communicate effectively to all levels of the organization and correctly identify the customer's needs.Expert knowledge of SQL. PL/SQL is a plus.
4. Knowledge of some operating system software including MVS/ESA, JES2, DFSMS, CICS, RACF, RMF, TSO/E, ISPF, Solaris, AIX and Windows 2003.
5. Knowledge of JCL and computer programming languages including COBOL.

Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action Employer, M/F/D/V.

Blue Cross and Blue Shield of Minnesota is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

J2W:DIC

Primary Location: United States-Minnesota-Eagan
Shift: Day Job]]>http://careers.bluecrossmn.com/job/Eagan-Database-Administrator-Job-MN-55120/1847255/184725518472552012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Summary:

The Senior UM Specialist is a critical component of BCBSM's Integrated Health Management team.

Generally, the position exists to promote appropriate, effective and efficient use of health care resources via pre- and post-service review, appeals and program and network referrals.

The scope of this position includes medical and surgical care and treatment.

Additionally, the Senior UM Specialist serves as a subject matter expert to team members and BCBSM.

Accountabilities:

1. Applies clinical experience, health plan benefit structure and claims payment knowledge to pre- and post-service reviews.

2. Gathers relevant clinical data through multiple sources.

3. Leverages clinical knowledge, business rules, regulatory guidelines and policies and procedures to determine clinical appropriateness.

4. Ensures that members have access to care across the network

5. Serves as a utilization management resource and shares expertise across market segments, department and division; e.g. partners with Dedicated Nurses and Behavioral Health Dedicated Clinicians.

6. Analyzes utilization management trends.

7. Coordinates with members and providers via multiple communication tools; e.g. phone, fax, letter.

8. Maintains outstanding level of service at all points of customer contact.

9. Demonstrates the behaviors inherent to the "Find a Way" culture; e.g. continuous learning, innovation to facilitate day to day accountabilities and enhance the overall performance of the department.

10. Serves as a subject matter expert to team members and BCBSM.

11. Commercial LOB: May be required to float to other UM departments as needed.

Qualifications

Required Qualifications:

1. Registered nurse with current MN license with no restrictions.
2. 3+ years relevant clinical experience
3. 1+ years of managed care experience; e.g. case management, utilization management and/or auditing experience.
4. International Classification of Diseases (ICD-9) knowledge and Current Procedural Terminology (CPT) coding experience.
5. Outstanding communication skills.
6. Outstanding analytical thinking skills.
7. Outstanding task facilitation skills.
8. Computer application proficiency.

Preferred Qualifications:

1. 3-5 years of RN experience telephonic skills.
2. Mentoring experience.
3. Process and project management experience

Blue Cross Blue Shield of MN is an Equal Opportunity and Affirmative Action Employer, M/F/D/V.

Blue Cross Blue Shield of MN is a drug free workplace.

Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Eagan
Shift: Day Job

Job Level: Experienced Professional]]>http://careers.bluecrossmn.com/job/Eagan-Medical-UM-Specialist%2C-Sr-Commercial-Operations-Job-MN-55120/1850492/185049218504922012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Job Summary:

This position will focus on ensuring there is adequate IT capacity to meet required levels of services and that acceptable availability targets are met. This includes conducting logical analysis of business, scientific, engineering and formulating mathematical models for senior management and correlate capacity to both business and demand and historical utilization patterns and recommends acquisitions, reallocation, and/or retirement of infrastructure components.

Additional responsibilities will include designing, developing and maintaining dashboard/s for Engineering and Executives to support the optimization of Blue Cross IT.

Accountabilities:

1. Identify, with appropriate team, capacity requirements through discussions with business users
2. Understand current usage of the infrastructure and IT services, and the maximum capacity of each component
3. Perform sizing on all proposed new and existing services and systems, using modeling techniques to ascertain capacity requirements.
4. Construct mathematical capacity models for base lining, trend analysis, analytical modeling or simulation modeling.
5. Forecast future capacity requirements based on bsiess places, usage trends, sizing of new service, etc.
6. Conduct regular review and revision of Capacity Plans in line with the organizations planning cycle
7. Ensure appropriate levels of monitoring are in place and maintained.
8. Analyze the usage and performance data, and report on performance against targets contained in Service Level Agreements
9. Raise incidents and problems when breaches of capacity performance thresholds are detected and assist with investigation and diagnosis of capacity related incidents and problems.
10. Identify and initiate tuning to be carried out to optimize and improve capacity or performance
11. Identify and implement initiatives to improve resource usage -for example, demand management techniques

Qualifications

Required Qualifications:

1. 10 years information services experience is required, to include 5 years in a capacity planning or performance measurement role.
2. Proven project management and team lead skills.
3. Statistical maturity as indicated by college level statistical methods course work.
4. Proficiency at quickly assimilating and analyzing large amounts of data, solving problems quickly and accurately.
5. Detailed knowledge of application server Software (e.g. middleware), Unix (AIX, Linux), Windows Server, Java, and Networking concepts (e.g. TCP/IP, Firewalls, network devices).
6. A sound understanding of operating system concepts and subsystem analysis and design (e.g. performance tuning, storage management, capacity planning.
7. Excellent communication skills, both written and oral. Must be able to effectively communicate to a broad spectrum of people, from operator trainees to company officers.
8. Advanced presentation skills, sound knowledge of software presentation tools, and SAS (on any platform) skills
9. Ability to thrive in a fast paced, exacting environment.

Preferred Qualifications:

1. Mainframe experience including z/OS, z/VM, zLINUX, and subsytems (e.g. RMF, SMF)

Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action Employer, M/F/D/V.Blue Cross and Blue Shield of Minnesota is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

J2W:DIC

Primary Location: United States-Minnesota-Eagan
Shift: Day Job

Job Level: Experienced Professional]]>http://careers.bluecrossmn.com/job/Eagan-Capacity-Planner-Senior-Job-MN-55120/1852733/185273318527332012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Summary:

The Test Lead Principal role has oversight of multiple Test Lead activities relating the testing efforts on medium to large scale projects. The role assures conformity to Enterprise testing practices and standards across all project or portfolio tracks as well as coordinates cross portfolio interactions and dependencies. This role is also charged with the oversight of estimating and resource planning at the portfolio level. This role working with Project Management, Application Development and multiple test teams, manages the analysis, design, planning and execution of testing for major corporate projects and initiatives. The role demonstrates extensive knowledge of all phases of the Software Development Life Cycle (SDLC) and techniques for creating a high value and technically-driven Test Team that is strong, independent, formal and unbiased.

Accountabilities:

1.
Manages the overall test planning activities and test team for large company wide projects, including testing scope, artifacts, timelines, and reviews. Capable of overseeing and coordinating a group of test leads and testers on any given project. Will have accountability for multiple projects or a single large program.

2.
Leads the analysis of test environment/test data requirements which includes the integration of several test systems.

3.
Creates and implements Teradata environments management processes for the Data Warehouse

4.
Creates and implements promotion path through the environment for db projects (table structrure changes, views, indexes, etc.), ETL code and performance tuning changes,

5.
Environments/deployments collision analyses

6.
Creates and implements environments synchronization process

7.
Implements data refresh process/schedule and manage data refreshes coordination in lower environments

8.
Other duties as assigned

Qualifications

Required Qualifications:

- Bachelor's degree in Computer Science, Business Administration or related topic and 8 years of test related experience in information services, including 6 years in a test leadership role. In lieu of degree, 12 years of test related experience in information services, including 6 years in a test leadership role.
- DBs understanding, Data Warehouse understanding
- SQL proficient
- Demonstrated analytical skills to be able to analyze projects/activities interdependencies
- Demonstrated coordination skills. Ability to work with different roles in EDIM (DBAs, Data Modelers, ETLers, Test and Information Delivery)
- Process driven
- Demonstrate strong technical knowledge of mainframe, client/server, or web-based environments
- Demonstrate strong technical knowledge of testing tools

Preferred Qualifications:

- Demonstrated human relation skills to effectively interact with all management levels, peers, subordinates, internal and external customers and vendors
- Strong leadership skills with solid hands-on management experience
- Customer-focused, ability to triage issues, react well to changes, and multi-task on multiple projects
- Advanced presentation skills and oral and written communication skills
- Demonstrated ability to influence and motivate individuals and teams
- Strong knowledge of database query and manipulation tools and techniques
- Experience with scripting and programming languages
- Experience with IBM Rational tools preferred
- Completed professional testing and/or test management certification (e.g., CSTE, CSTP, CMST, CTM)

BlueCross BlueShield of MN is an Equal Opportunity and Affirmative Action Employer, M/F/D/V.BlueCross BlueShield of MN is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Eagan
Shift: Day Job

Job Level: Experienced Professional]]>http://careers.bluecrossmn.com/job/Eagan-Test-Lead-Pr-Job-MN-55120/1855181/185518118551812012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Job Summary:

Install, maintain, and provide 24x7 system support for Microsoft Windows Server, Novell Netware, and VMware vSphere operating system software and hardware. Technical Engineer Senior role will analyze and evaluate customer requirements characterized by technical and analytical requirements. Strong collaboration with Security Administrators, Application Owners, Capacity Planning & Monitoring, Service Desk, and Network Administrators when designing and implementing computer systems utilizing "state of the art" concepts, techniques and languages. Responsible for planning, developing, testing and documenting computer systems and follow up to ensure success of the Intel environment.

Key Accountabilities:

1. Build and administer Microsoft Windows Servers including Active Directory infrastructure.

2. Build and administer VMware infrastructure for virtual desktops and servers.

3. Administer Novell NetWare 6.5 including security configuration and Novell eDirectory management.

4. Apply scheduled operating system software maintenance.

5. Install and maintain various ISV products from EMC, CA, and others.

6. Manage migrations from older hardware / software to new.

7. Upgrade firmware during scheduled maintenance windows.

8. Identify, automate, and script repeatable processes.

9. Maintain disaster recovery warm site environment.

10. Coordinate with vendor to replace failed hardware.

11. Create and update team documentation.

12. Participate in 24x7 on-call support rotation.

Qualifications

Required Qualifications:

1. Microsoft Windows Server 2000, 2003, 2008 experience including automated installation, configuration and patching

2. VMware vSphere virtualization experience

3. Novell 6.5 experience

4. HP Intel hardware experience

5. Experience using storage multi pathing software in a large SAN environment (Veritas Volume Mgr, EMC Powerpath)

6. Thorough knowledge of TCP/IP networking and associated protocols

7. Bachelor's degree in Computer Science, Mathematics, or related field and 3 years of experience to include leading Intel activities, or 7 years of experience in lieu of a degree.

Preferred Qualifications:

1. VMware ESXi 5 experience

2. Windows 2008 experience including security configuration and Microsoft Active Directory management

3. Redhat experience

4. Experience using Powershell, Perl, or other scripting languages

5. OS level clustering experience

6. Demonstrated ability to work independently

7. Demonstrated ability to communicate effectively and collaborate to all levels of the IT organization and correctly identify the needs of customers

Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action Employer, M/F/D/V.

Blue Cross and Blue Shield of Minnesota is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

J2W:DIC

Primary Location: United States-Minnesota-Eagan
Shift: Day Job]]>http://careers.bluecrossmn.com/job/Eagan-Technical-Engineer-Senior-Job-MN-55120/1857984/185798418579842012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Summary:

This high level sales position develops, directs and gains executive certification of an account business plan for key jumbo accounts. The incumbent executes the plan for revenue, growth, operational effectiveness and profitability by leading a cross-functional team. The incumbent manages the relationships with a broad range of executive and staff contacts within Blue Cross and the client to ensure business objectives are met and client loyalty is achieved using the most efficient and effective resources.

Accountabilities:

- Creates, and gains formal executive certification of a client business plan for retention, growth, operational effectiveness and profitability.

- Be a knowledge leader in emerging market issues, and be consultative and interactive with clients about innovation, opportunities, and solutions that translate into being a trusted resource for the client.

- Leads the cross-divisional execution of the business plan to ensure corporate growth and revenue targets are achieved by the dates specified.

- Leads client negotiations for products, services and prices using exceptional strategic selling skills including discovery, sales cycle's maintenance, tactical planning and closing in a complex sales environment.

- Establish, build and maintain positive, professional relationships at all decision levels within assigned accounts and within Blue Cross according to a defined relationship management plan.

- Builds high customer satisfaction and loyalty.

- Delivers value-added solutions using a professional consultative selling approach to ensure client loyalty and efficiency of Blue Cross resource use.

- Communicate emerging market trends, client issues, and opportunities in a solution oriented manner.

- Keep management apprised and make recommendations.

- Serve as a corporate resource in strategy, product, solution development and staff mentoring

- Demonstrate continuous learning and leadership in the industry and profession.

Qualifications

Required Qualifications:

- Bachelor's degree in business or marketing and 5 yrs of account management, sales or consulting experience in healthcare or employee benefits; or, in lieu of the degree, 9 yrs of account management, sales or consulting experience in healthcare or emplyee benefits is required

- Working knowledge of key health plan functions including marketing, operations, and finance is required in order to develop an account business plan

- Ability to develop an account business plan and obtain executive certification of that plan

- Displays strong ability to lead cross-functional teams, drive product and strategy development and execution

- Ability to apply expert selling and account management skills in ambiguous or complex situations with five years in the profession

- Excellent communications and interpersonal skills (internal/external)

- Ability to work across systems and functions to facilitate solutions and capabilities development.

- Demonstrated creativity in solution development with strong sense of urgency

- Positive thinker/self starter

- Skillful negotiator, ability to influence internal and external customers

- Leadership skills

BlueCross BlueShield of MN is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. BlueCross BlueShield of MN is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Eagan
Shift: Day Job]]>http://careers.bluecrossmn.com/job/Eagan-Principal-Account-Manager-Major-Accts-Job-MN-55120/1860415/186041518604152012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Summary:

This position is responsible for the regional call center, which includes setting staffing levels, budget, training, quality assurance, and oversight programs. Directs and supports the call center staff toward the achievement of regional contractual obligations and goals. Leads through personal example by providing coaching, training, and oversight while instilling best practices in the call center. This position also must ensure compliance with CMS, Federal and State regulatory requirements, as well as BCBSM internal policies and procedures.

Accountabilities:

1. Hire, educate, develop and motivate market focused professionals to meet call center metrics as defined by the regional contract.

2. Responsible for relationship with call center management staff as well as regional partners as it pertains to the call center.

3. Manage the department including interviewing and hiring employees following required EEO and Affirmative Action guidelines and ensuring employees receive the proper training. Conducts performance evaluation, and is responsible for managing employees, including skill and career development, policy administration, coaching on performance management and behavior, employee relations and cost control.

4. Manage, monitor and coach staff to insure compliance with all CMS, Federal and State regulatory requirements, and BCBSM policies and procedures.

5. Collaborate with internal and external business partners to ensure market plans are followed and modify as market input dictates. Monitor and identify process improvement opportunities, resource needs and solutions.

6. Implement sound practices and prioritize work assignments.

Qualifications

Required Qualifications:

- Bachelor's degree in business or, marketing, and 5 years industry experience.

- 3 years experience managing projects involving multiple team members and including task assignment, working with key customers, managing team and customer relationships and managing project deliverables.

- Knowledge of the Medicare and Individual market.

- Training expertise

- Proven oral and written communication skills.

- Ability to motivate and mentor sales personnel and proven track record of driving strategic plans in a given market.

- Some travel will be required.

- Currently possesses or will acquire a Minnesota health and life license within 60 days of starting the Sales Manager job.

BlueCross BlueShield of MN is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. BlueCross BlueShield of MN is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Eagan
Shift: Day Job]]>http://careers.bluecrossmn.com/job/Eagan-Manager%2C-RAS-Call-Center-Job-MN-55120/1865799/186579918657992012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Job Summary:

This position is responsible for performing data analysis and participating or leading small data driven strategic or tactical projects to enable the Business to perform strategic data decision-making. The incumbent is able to work within their team to assist in planning deliverables, assist in estimating, perform data analysis, design and implementation of data solutions with assistance. The incumbent will participate in projects or enhancement initiations taking the solution through development, testing, business acceptance approval and implementation. They will provide SAS Business Intelligence consultation, providing services to business and other IT areas throughout the company. They may assist in incident support, coordinate work with both on and off-shore resources and mitigate risk through multiple technical and business relationships.

Accountabilities:

1. Works with various business and technical staff to understand or communicate data and software problems.

2. Participates as a technical resource in design, development, testing and debugging the BI solution or coordinating/leading projects or enhancements to current applications.

3. Resolves customer complaints with a high level of customer service and recognizes and suggests improvements and enhancements.

4. Assists project manager in developing project plans, schedules, status reporting, and issue/risk management. Will assist in coordination of project activities by defining staff needs and monitoring unit work to remain within the defined timeline, budget and scope.

5. Able to participate in the design, documentation and/or development of the user interface, metadata, stored procedure components and reports of the BI Solutions.

6. Makes recommendations to modify procedures to solve problems considering performance, capacity limitations, operating time and corporate architecture guidelines.

Qualifications

Required Qualifications:

1. Bachelors degree in Computer Science or related field and minimum of 2 years of related experience developing reporting and analytical programs in a variety of languages like SAS EG, SAS BI, Business Objects, or other business intelligence tools.
2. In lieu of a degree, requires 6 years of related experience developing reporting and analytical programs in a variety of languages like SAS EG, SAS BI, Business Objects, or other business intelligence tool.

Preferred Qualifications:

1. Demonstrated analytical, system and problem solving skills to apply conceptual thinking to situations and to create and innovate new solutions.
2. Strong oral/written communication skills to effectively communicate business and technical information to non-technical audiences including peers and internal and external vendors.
3. Ability to design, evaluate and interpret data solutions applying them to Blue Cross technical, business and industry knowledge.
4. Ability to work independently and within a team of individuals having diverse cultural or professional backgrounds including business, technical and /or clinical.
5. Demonstrated support and develop of Business Intelligence user interfaces, information maps, reports and supporting code to meet the operation level agreement (OLA) and service level agreement (SLA).
6. Ability to participate or lead small teams/units in analytical software development solutions.
7. Willing to learn independently or on the job.Preferred Qualifications:
8. Understanding of software development and project methodologies- Introduced to SAS BI Toolset, SAS Enterprise Guide and SQL- Knowledge of manage care and health care claims industry.

Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action Employer, M/F/D/V.

Blue Cross and Blue Shield of Minnesota is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

J2W:DIC

Primary Location: United States-Minnesota-Eagan
Shift: Day Job]]>http://careers.bluecrossmn.com/job/Eagan-Information-Delivery-Tech-Lead-Job-MN-55120/1867863/186786318678632012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Summary:

This position does research and prepares business and/or financial analysis, negotiates fees, analyzes processes, business conditions and other related areas. Uses computerized systems (PC and/or mainframe) to create reports, charts and presentations of data developed. Uses computerized systems (PC and/or mainframe) to create reports, graphs, and charts of data developed. May assist in the development of organization business policies, conducts financial and business related studies and cooperates with other departments/organizations in the preparation of analyses.This position is responsible for the development of new and retention of existing national business, through participation in the sales and marketing effort for Control and Par Plan business. In addition, this position is responsible for facilitating operational activities associated with National Business, establishing and enhancing Partner Blue Plan relationships that support growth and retention of national account business.

Accountabilities:

1. Maintain key relationships with Partner Blue Plans that will promote BCBSMN as a vital partner in the delivery of health care in a national arena.

2. Negotiate the annual administration fees, performance and claim cost guarantees, and other fees with Partner Blue Plans in participating and control arrangements to ensure that financial arrangements are competitive with marketplace demands, limit BCBSMN's exposure to adverse risk and are consistent with corporate objectives.

3. Understand Consortium of Health Plans (CHP) and their relationship to National Accounts including the importance of the CHP transfer pricing methodology for administrative fee negotiations

4. Develops areas of expertise in assigned states that would encompass products, system capabilities, networks, competition, legislation, etc. through site visits and written and verbal communications

5. Leads assessment sessions with management for business process planning and strategy development.

6. Facilitates the communication and connection of health care plans in multi-state locations of national account business for all service plan locations to ensure that account requirements are met.

7. Documents performance measurements and process changes.

8. Facilitates cross-functional interfaces and impacts on all impacted organizations, which includes cultural concerns and barriers.

9. Delivers account presentations of benefit plans, enrollment procedures, etc. at local enrollment meetings when BCBSMN is a Par Plan, and at Par Plan locations when BCBSMN is a Control Plan.

Qualifications

Required Qualifications:

- Bachelors degree in Business, Marketing or equivalent field and 5+ years of previous marketing or customer relations experience; or 9 years of previous marketing or customer relations experience, in lieu of a degree.

- Broad knowledge of health insurance and national business products and capabilities.

- Proven ability to exercise tact and diplomacy even in stressful situations.

- Excellent oral and written communication skills.

- Excellent organization and problem solving skills with the ability to project a service attitude.

- Proven negotiating and consulting skills.

- Flexibility to handle a variety of responsibilities.

- Ability to develop and present formal presentationsAbility to be self-motivated and to work with minimal supervision in a highly visible position

- Thorough understanding of BCBSMN operations, sales techniques and funding arrangements

- Intermediate level project management skills.

- Some overnight, long distance travel may be required.

BlueCross BlueShield of MN is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. BlueCross BlueShield of MN is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Eagan
Shift: Day Job]]>http://careers.bluecrossmn.com/job/Eagan-Senior-National-Business-Consultant-Job-MN-55120/1867865/186786518678652012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Summary:

This position is responsible for managing and leading care management activities on an integrated health management team, ensuring high quality care management and adherence to regulatory and compliance standards for commercial and / or government program lines of business.

Accountabilities:

1. Manages and leads the overall care management activities of the team which includes budget and day to day operations. Evaluates workflow and efficiencies, and makes necessary changes to diminish risk and enhance process improvements.

2. Initiates, leads, and facilitates cross-functional planning and implementation of initiatives within the division.

3. Participates and contributes in enterprise wide initiatives.

4. Coordinates the development, revision, and implementation of care management policies and procedures.

5. Assures consistency in processes and function across teams through auditing and solid business practices.

6. Assures compliance with regulatory and accreditation requirements, contract agreements, performance guarantees and participates with onsite account and provider meetings.

7. Participates in provider and regulatory site reviews as needed.

8. Coaches, mentors and holds staff accountable to assure that department and performance goals and objectives are met.

9. Collaborates with leadership and staff on planning by providing input on decision making processes to ensure that departmental, team and individual goals and objectives are met.

10. Participates in the education of providers, employer groups and other purchasers and internal departments on care management operations.

11. Assures that quality standards and continuous quality improvement (CQI) activities are met by leading project groups and utilizing the CQI process to obtain department goals and/or BCBSM vision.

12. Manages the department within the parameters of Human Resources policies, practices, and guidelines of BCBSMN.

Qualifications

Required Qualifications:

- Current RN licensure in the state of MN without restrictions or pending restrictions.
- For Behavioral Health positions, a licensed independent mental health specialist or RN; must be licensed in the state of MN to practice independently without supervision.
- 7 years of relevant direct clinical care or managed care experience.
- Previous experience in care management processes preferably in a health plan.
- 3 years of management experience required, which may include progression as a team lead, charge nurse, or project manager.
- Demonstrated knowledge, skills, and abilities in a leadership role.
- Demonstrated ability in managing, communicating and meeting time lines and performance metrics.
- Critical thinking skills with proven ability to identify and implement process improvements.
- Effective verbal and written communication skills.

Required Qualifications specifically for Case and Disease Management positions:

- Current RN licensure in the state of MN.
- For Government Program positions, current RN licensure or LSW.
- CCM or ability to become certified within 3 years functioning in the manager position.
- 3 years of management experience required Preferred Qualifications:
- Bachelors degree in health field.

- 5 years of management experience.

BlueCross BlueShield of MN is an Equal Opportunity and Affirmative Action Employer, M/F/D/V.BlueCross BlueShield of MN is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Eagan
Shift: Day Job

Job Level: Manager]]>http://careers.bluecrossmn.com/job/Eagan-Mgr-Integrated-Health-Mgmt-Job-MN-55120/1867868/186786818678682012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Job Summary:

This position has primary accountability for leading the detail design, construction, integration, and implementation of technical deliverables in large application development projects. The position is responsible for working with business areas, project teams, IT technical teams, and outsource vendor partners to achieve project success.

Accountabilities:

1. Works with technical staff to understand complex software solutions involving many varied technologies, components, and platforms.

2. Participates as a technical expert in design, development, coding, and testing, of new software or making significant enhancements to existing software.

3. Contributes to conceptual design.

4. Responsible for the review and acceptance of code deliverables, documentation, and other project artifacts.

5. Accountable for completing design deliverables, including preparation of detail specifications from which applications will be developed.

6. Assists project managers in developing technology requirements and estimates.

7. Provides direction to off-shore vendor partner software developers.

8. Works closely with customers and technical team members to understand business requirements that drive the analysis and quality of technical solutions.

9. Accountable for the development of technical documentation for the knowledge transfer of new applications to application support teams

Qualifications

Required Qualifications:

1.
Bachelor's degree in Management Information Systems or a related field and a minimum of 4 years of software development experience. A minimum of 8 years of software development experience in lieu of a degree.

2.
Experience in developing and delivering software projects and solutions utilizing distributed technologies including Websphere, Java, SOA services, and Rational tools

3.
Demonstrated ability to design and develop software.

4.
In-depth knowledge of infrastructure components including security, connectivity, database management systems, and EDI.

5.
Excellent analysis and problem solving skills.- Excellent verbal and written communication and presentation skills

6.
Demonstrated human relations skills to effectively interact and collaborate with management, peers, and vendors.

7.
Demonstrated understanding of the standards and deliverables to ensure integrity of the development process.

8.
Demonstrated ability to influence and motivate individuals and teams.Preferred Qualifications:

9.
General knowledge of BCBS business areas. - Health Care Industry knowledge

10.
Technical Certification

11.
Knowledge and understanding of Agile development practices and methodologies.

Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action Employer, M/F/D/V.BlueCross Blue Cross and Blue Shield of Minnesota is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

J2W:DIC

Primary Location: United States-Minnesota-Eagan
Shift: Day Job]]>http://careers.bluecrossmn.com/job/Eagan-Application-Project-Delivery-Tech-Lead-Senior-Job-MN-55120/1867869/186786918678692012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Job Summary:

Plans, directs, and coordinates activities of designated projects, including the initiation, design, development, implementation, maintenance, and support of computer application systems. The Project Manager also communicates status of the project and manages the change control function of the project; identifies and manages project risk; resolves problems and issues that arise during the project; provides direction to individual project team members and in some cases sub-project Project Managers. This is accomplished by performing the following duties personally or through direction of the program director.

Accountabilities:

1. Under the direction of the PMO, develop and closely manage project plans, schedules and budget for projects up to or greater than 5MM, and with teams of 10 -20 people
2. Maintain communication regarding project status, risks, issues, and priorities
3. Provide written and verbal executive communication
4. Assign resources
5. Support achievement of project team member performance objectives and provide performance feedback
6. Document and implement repeatable project management processes, and participate in continuous improvement initiatives
7. Communicates with all levels of the organization (including Executive level) regarding the project status, issues, risks and other pertinent information.
8. Estimate the resources necessary to achieve project goals; recruit additional resources during the project cycle if necessary
9. Draft and submit the project budget, and recommend changes to the budget where necessary
10. Identifies the project dependencies and the critical path and manages them during the project cycle
11. Develops methods to monitor project progress and provides corrective coaching and direction if necessary
12. Manages the project scope and identifies and manages project risk.
13. Conducts project closeout and completes the project file.
14. Remain knowledgeable of company business and technology, including architecture principles, information applications, and technology
15. Maintain an active PMI membership
16. Pursue continuing education necessary to maintain PMP certification and other certifications

Qualifications

Required Qualifications:

1. BA/BS, and 6 years of related work related experience, in Technology or Business area (i.e. Computer Science, Healthcare, Insurance), or 10 years of related work experience in Technology or Business area (i.e. Computer Science, Healthcare, Insurance) in lieu of a degree 3+ years of project management experience.
2. 3+ years experience in software development lifecycle (SDLC)
3. Requires 2 years Data Warehouse experience

Preferred Qualifications:

1. Professional certification (PMP) and prefer active participation in professional societies such as a PMI chapter or similar organization.
2. 2+ years program management experience.
3. RUP training or iterative methodology experience desirable
4. Previous experience with overall project and/or program responsibility for large scale projects involving 15 -20 people and budgets of 5MM or greater.
5. Proven experience in driving effective stakeholder status, decisions, and communications.
6. Demonstrated track record of successful project delivery within budget, schedule, scope and quality.
7. Strong portfolio and project management skills, including planning, execution, and control of projects.
8. Strong analytical and team-based problem solving skills.
9. Ability to negotiate resolution of issues and conflicts.
10. Ability to lead and facilitate cross-functional teams.
11. Proficiency with project management tools, such as Microsoft Project for scheduling, Clarity for portfolio management, or similar project management tools/applications.

Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. Blue Cross and Blue Shield of Minnesota is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

J2W:DIC

Primary Location: United States-Minnesota-Eagan
Shift: Day Job]]>http://careers.bluecrossmn.com/job/Eagan-IT-Project-Manager-Senior-Job-MN-55120/1867870/186787018678702012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Summary:

This position is responsible for the design, development, implementation and evaluation of new programs, expansion or improvement of current programs. The individual will have primary accountability for leading projects, coordinating and collaborating with staff in the Health Management and other divisions, meeting project objectives. This position will work closely with leadership to provide these services and will lead cross-functional, cross-divisional teams to achieve desired outcomes within tight deadlines.

Accountabilities:

1. Leads cross-functional planning and implements or oversees the implementation of new, expanded, or improved internal and/or external health management projects ensuring they comply with regulatory and accreditation requirements. Projects often involve several partners and may require collaboration with external entities, requiring expertise in developing and maintaining strong business relationships as well as developing and implementing communication plans.

2. Develops and continually updates program or project plans, timelines, and deliverables while coordinating multiple sub-processes to develop, expand or improve programs.

3. Drives to and delivers high quality solutions with aggressive timeframes and high level stakeholder satisfaction

4. Develops and implements a communication plan in conjunction with leadership to support the initiative including communicating to key internal stakeholders.

5. Develops appropriate standards such as work methods, data analysis which may include barrier analysis, measurement plan, performance measures, and other resources to support the project.

6. Develop presentations highlighting findings, analysis, recommendations and action plans.

7. Develops and maintains positive relationships with key stakeholders both internal and external which may include public health agencies, employers, community leaders, American Association of Health Plans, BCBSA, MDH, MPAAT, American Heart Association, American Lung Association, etc as needed to collaborate on projects designed to improve health outcomes.

8. Develops and manages vendor contract(s); manages project budget(s).

9. Perform other accountabilities as assigned.

Qualifications

Required Qualifications:

- Bachelor's degree in business, nursing, public health, health science, health promotion or related field or equivalent education and experience.
- 5 years related experience; i.e. experience working on or leading projects in a health care setting or in a setting requiring these same skills and ability.
- Demonstrated track record of achievement with ability to identify and deliver customer expectations
- Excellent continuous quality improvement and/or project management skills
- Creative problem solving skills, adapting approach as needed
- Excellent verbal, written and presentation and communication skills
- Excellent facilitation and relationship building skills
- Proven ability to define problems, collect and analyze data, and transform into project-level strategies
- Demonstrated ability to work independently and make decisions as needed.
- Travel may be required

Preferred Qualifications:

- Master's degree in business, nursing, public health, health sciences, health promotion or related field.
- Experience in process improvement.
- Content expertise in the reduction of health risk behavior
- Experience working in/with diverse racial or ethnic groups and nations

Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. Blue Cross and Blue Shield of Minnesota is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Eagan
Shift: Day Job]]>http://careers.bluecrossmn.com/job/Eagan-Health-Management-Business-Project-Manager-Job-MN-55120/1882157/188215718821572012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Summary:

The UM Specialist is a critical component of BCBSM's Integrated Heath Management team.

The position exists to promote appropriate, effective and efficient use of health care resources via pre and post service review, benefit management, education and program referrals.

Accountabilities:

1. Applies clinical experience, health plan benefit structure and claims payment knowledge to pre and post-service reviews.

2. Gathers relevant clinical data through multiple sources.

3. Leverages clinical knowledge, business rules, regulatory guidelines and policies and procedures to determine clinical appropriateness.

4. Serves as a utilization management resource and shares expertise across department and division; e.g. partners with Clinical Guide and Dedicated Clinician.

5. Analyzes utilization management trends.

6. Coordinates with members and providers via multiple communication tools; e.g. phone, fax, and letter.

7. Represents utilization management on division wide committees; e.g. Coding and Reimbursement, Pay as Medicare and Medicaid Pays.

8. Maintains outstanding level of service at all points of customer contact.

9. Collaborates and coordinates with team members to facilitate day to day functions and enhance the overall operation of the department.

Qualifications

Required Qualifications:

- RN with MN license without restrictions or pending restrictions.
- 1 - 3 years relevant clinical experience.
- Outstanding communication skills.
- Outstanding analytical thinking skills.
- Outstanding task facilitation skillsInternational Classification of Diseases.
- ICD 9) knowledge and Current Procedural Terminology.
- (CPT) coding experience.
- Strong computer application skills.

Preferred Qualifications:

- 1 - 3 years of managed care experience; e.g. case management, utilization management.
- 3 - 5 years of RN experience.
- Outstanding telephonic skills.
- Medicare and/or Public Programs experience.

BlueCross BlueShield of MN is an Equal Opportunity and Affirmative Action Employer, M/F/D/V.

BlueCross BlueShield of MN is a drug free workplace.

Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Eagan
Shift: Day Job

Job Level: Experienced Professional]]>http://careers.bluecrossmn.com/job/Eagan-Medical-UM-Specialist-Public-Programs-Job-MN-55120/1882158/188215818821582012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Summary:

This position is responsible for providing leadership development administrative, program and communications support for the Leadership Development team. The position is designed to positively impact the implementation and execution of the leadership development strategic plan across the organization.

Accountabilities:

1. Create, manage and maintain nomination lists and master leadership development program schedule.
2. Provide learning management system set-up and maintenance for all leadership development programs and initiatives (program descriptions, sessions, evaluations.)
3. Manage materials distribution /updates/ preparation for key leadership programs and initiatives.
4. Provide support for aspects of Succession Management, as needed, to include report generation and profile creation.
5. Provide project management support for Talent Review, as needed, to include leading and managing the development and maintenance of the master calibration scheduling calendar, session preparation, report generation and serve on core execution team.
6. Gather and prepare data compilation for leadership development program metrics.
7. Research and recommend alternative solutions for processes or system enhancements that would result in more efficient/ effective work products.
8. Create and/ or prepare PowerPoint presentations as required.
9. Work with consultants to identify and request procurement support and serve as liaison with procurement, as required, to assist with vendor contract execution/ management.
10. Provide administrative assistance to contractors, and external facilitators, as needed.

Qualifications

Required Qualifications:

- High school diploma and 5 years of administrative experience that includes 3 years of Learning Management System or other Human Resources system support experience; data entry, report generation, and general systems knowledge.
- 2 years of program or event coordination experience.
- Demonstrated negotiation and problem solving skills Large project coordination experience.
- Demonstrated written and verbal communication skills with all levels in the organization.
- Attention to detail and accuracy.
- Ability to manage confidential information.
- Demonstrated proficiency in Word and PowerPoint and Excel (reporting).

Preferred Qualifications:

- Experience within a learning organization.

BlueCross BlueShield of MN is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. BlueCross BlueShield of MN is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Eagan]]>http://careers.bluecrossmn.com/job/Eagan-Leadership-Development-Coord-Job-MN-55120/1882159/188215918821592012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Summary:

The Director of Provider Transactions is accountable for optimizing internal systems and processes to ensure timely, efficient and mutually satisfying conduct of business between Blue Cross and its network of providers and for addressing service and operational issues brought forth by providers.

The Director is responsible for business transactions between Network Management and contracted health care entities including hospitals, physicians and allied health professionals.

The scope of business transactions includes:

1) Addition of providers to the network and on-going maintenance.

2) The creation of provider service contracts and their implementation.

3) Coding and payment of claims.

4) Implementation of standard, non-negotiated provider service contracts.

5) Implementation and management of provider networks.

6) Regulatory compliance, audit and risk-mitigation.

7) Provider education.

8) Electronic portals and non-electronic informational and transactional services to providers.

Accountabilities:

1. Direct the process of credentialing providers in accordance with criteria established by Blue Cross’ Credentialing Committee in a timely manner and in close collaboration with the credentialing functions of contracted health care entities and potentially other health plans as a shared administrative function.

2. Ensure an accurate and comprehensive repository of provider demographic data and efficient databases and reporting systems to facilitate the processing of payments, creation of maintenance of networks and provider directories and other business functions which rely on provider information.

3. Implement provider service contracts negotiated by the Director of Provider Contracting and their staff with accountability for accurate loading of payment schedules into the claims payment system in an efficient and timely manner.

4. Conduct routine audits to verify contracts are loaded into the system correctly and payments are in concordance with the terms of the contract and associated payment schedules.

5. Direct staff who develop provider service agreements which reflect the business objectives and the financial and non-financial terms of the negotiated agreements developed by the Director of Provider Contracting and Director of Provider Performance, Pricing and Interplan Management. Ensure effective collaboration with and review of service agreements by Blue Cross’ Legal and Audit/Risk Management departments as necessary.

6. Ensure efficient processes are in place to respond to provider inquiries regarding operational issues related to claims submissions, payment accuracy, denials and appeals, coding, accuracy of payment and other problems.

7. Manage the healthcare coding policy for the organization, including provider claims are accurately and appropriately coded upon submission utilizing editing software and coding staff to make necessary denials and corrections.

8. Educate providers on both practice-specific and systemic reasons for denials and optimal coding practices. The Director will also respond to provider inquiries on denials and facilitate resubmissions and appeals in a timely and transparent manner.

9. Implement standard, non-negotiated provider service agreements and fee schedules in collaboration with the Network Performance, Pricing and Interplan Management and the Director of Provider Contracting.

10. Ensure Network Management meets accreditation established by NCQA, TriCare, and other relevant organizations and is in compliance with State and Federal regulations developed by the Minnesota Department of Health, CMS and other agencies and legislation such as HIPAA compliance requirements and pass routine audits.

11. The Director will direct staff to audit business processes for accuracy, efficiency and compliance with corporate policies and coordinate the development of the enterprise risk management and business continuity plans for Network Management.

12. Define business strategy and content needs for electronic portals to support provider transactions, the exchange of financial, cost and quality information and contractual and business documentation with health care entities and providers in collaboration with the IT department.

13. Develop and oversee infrastructure and channels to support provider communication and education needs of Network Management in collaboration with the Marketing and Communications Department.

14. Collaborate with IT and Operations leadership to define and develop operational processes and systems to ensure achievement of performance measures.

15. Manages the department including interviewing and hiring employees following required EEO and Affirmative Action guidelines and ensures employees receive the proper training.

16. Conducts performance evaluation, and is responsible for managing employees, including skill and career development, policy administration, discipline, employee relations and cost control.

Qualifications

Required Qualifications:

- Accepting this director level position at BCBSMN requires signing an Agreement Regarding Non-Disclosure of Confidential Information and Non-Competition as a condition of employment.
- Bachelors Degree in Business or related field.
- 10 years of management experience in the health care industry with relevant experience in health plan operations and provider contracting including credentialing, coding, network maintenance, provider service contract development and provider demographics.
- Experience within a health care provider setting related to revenue management or payer relations.
- Working knowledge of provider reimbursement methodologies for professional, facility and ancillary services including DRG and CPT based payment methodologies.
- Demonstrated leadership skills and experience achieving corporate and divisional goals through collaboration and teamwork.
- Business expertise and interpersonal skills to effectively work within a complex organization to influence change and to build strong relationships with external constituencies including customers, providers and vendors.
- Delegation, supervisory and mentoring skills.
- Demonstrated success with problem-solving and complex operational and process improvement initiatives.
- Ability to work independently and to make sound business decisions.
- Familiarity with information technology utilized by health plans to exchange information among divisions and to conduct transactions with providers.
- Demonstrated ability to achieve performance metrics and manage operating and capitol budget.
- Strong leadership skills and experience leading cross functional teams.
- Delegation, supervisory and mentoring skills.
- Demonstrated problem solving, critical thinking and analytical skills.
- Preferred Qualifications:
- Master’s Degree in Business, or a related field Training and experience in quality and process improvement methodologies such as six sigma or LEAN. Experience with provider education related to coding or claims payment.

- BlueCross BlueShield of MN is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. BlueCross BlueShield of MN is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Eagan]]>http://careers.bluecrossmn.com/job/Eagan-Dir-Provider-Transactions-Job-MN-55120/1882160/188216018821602012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Summary:

This position is responsible for acting as the liaison between Blue Cross Blue Shield of Minnesota and the state and/or federal governments when revenue discrepancies are identified. The Reimbursement Analyst works in conjunction with the Reimbursement Specialists within the department as well as external stakeholders to research and resolve payment discrepancies.

Accountabilities:

1. Take ownership of assigned special statuses (i.e. Institutional, Hospice, End Stage Renal Disease, etc) and become a Subject Matter Expert for the team.

2. Analyze and reconcile reports related to assigned statuses.

3. Assist in tracking member discrepancies from identification through resolution.

4. Assist in performing monthly institutional verification via phone calls to providers.

5. Collaborate with the Membership department to reconcile conflicting CMS and NMBS data.

6. Assist in administering the Working Aged survey including tracking and follow-up calls to members.

7. Communicate regularly with CMS/DHS to resolve issues.

8. Generate Regional Office correspondence and required documentation to gain resolution of issues.

9. Represent the Reimbursement Management department during CMS/DHS audits including file preparation activities.

10. Identify process improvements and drive the implementation of identified efficiencies.

Qualifications

Required Qualifications:

- Bachelor's degree or 4 years of related Medicare/Medicaid experience.
- Knowledge of Medicare and/or Medicaid enrollment processes and their effect on reimbursement required.
- Proven ability to work independently.
- Ability to understand complex government regulations and instructions.
- Excellent written and verbal skills.
- Ability to work in a fast paced environment while demonstrating flexibility in work assignment and work overtime as needed.
- Experience participating in regulatory audits.
- Detail oriented analytical skills, strong initiative and ability to work in a team environment.

Preferred Qualifications:

- Previous telephone and customer service experience.
- Previous CMS reconciliation experience.
- Previous experience working with claims.

BlueCross BlueShield of MN is an Equal Opportunity and Affirmative Action Employer, M/F/D/V.

BlueCross BlueShield of MN is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Eagan
Shift: Day Job]]>http://careers.bluecrossmn.com/job/Eagan-Medicare-Reimbursement-Analyst-Job-MN-55120/1882161/188216118821612012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Summary:

This position provides supervision and support to a Consumer Service Center Team that reviews benefit and eligibility determinations filed as appeals or grievances by members, providers and other regulatory/legal entities on behalf of the member.

Accountabilities:

Provide supervision and support to team activities by planning, prioritizing and allocating resources in order to achieve business performance measures and completion of work in accordance with regulatory requirements.

Supervise the department including interviewing and hiring employees following required EEO and Affirmative Action guidelines and ensuring employees receive the proper training.

Conduct performance evaluation, and is responsible for managing employees, including skill and career development, policy administration, coaching on performance management and behavior, employee relations and cost control.

Create an environment that motivates and engages employees to work effectively as a team.

Monitor daily workflow and identify changes required in the distribution of work within the department to assure efficient completion of all appeals within the required timeframes.

Manage the identification and expedition of priority cases.

Assists in the preparation of cases for external review (MAXIMUS).

Assist in the preparation of cases for the Corporate Appeals Committee.

Key participant in the evaluation and implementation of processes, procedures, workflows and letters and recommends improvements to enhance the appeal process as part of the service continuum.

Participate in internal work-groups/committees in support of business work flows/requirements.

Qualifications

Required Qualifications:

Associates degree and 4+ years experience in healthcare, insurance or related industry or 6 years of healthcare, insurance or related industry experience in lieu of a degree.

1 + year demonstrated leadership experience or supervisory experience.

Strong knowledge of regulatory requirements for complaints, appeals and grievances.

Demonstrated ability to coach and mentor others.

Strong interpersonal skills and experience building relationships.

Demonstrated strong organizational skills.

Demonstrated strong analytical and problem solving skills.

Excellent communication skills with demonstrated ability to develop accurate and appropriate communications.

Knowledge of organization.

Demonstrated experience providing work direction.

Strong knowledge of excel, access or other database programs.

Preferred Qualifications:

Bachelor's degree

Consumer/provider liaison experience

BlueCross BlueShield of MN is an Equal Opportunity and Affirmative Action Employer, M/F/D/V.BlueCross BlueShield of MN is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Eagan
Shift: Day Job

Job Level: Experienced Professional]]>http://careers.bluecrossmn.com/job/Eagan-Supervisor-Consumer-Service-Center-Job-MN-55120/1882162/188216218821622012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Summary:

This position is responsible for managing the business relationship between Blue Cross and designated providers.

This includes effectively analyzing, organizing, developing and implementing service and system solutions, which improve costs and efficiency for both providers and Blue Cross.

Accountabilities:

1. Develops and maintains positive business to business relationships with providers through meetings, phone work or email. This includes understanding and documenting market intelligence.

2. Organize, prepare and facilitate provider meetings including creating agendas, maintaining issue logs and documenting appropriate information in NMC tools.

3. Performs internal facilitation for the following provider issues: contract implementation, data updates, termination, referral process, health benefit products, EC setup, reports etc as needed.

4. Identifies, facilitates and resolves complex service issues on a consistent basis by utilizing appropriate internal resources and asking appropriate questions in order to bring the issue to closure to the satisfaction of provider and Blue Cross.

5. Identifies global issues affecting providers on a consistent basis, brings forward issues to team and consistently keeps up maintenance on the log.

6. Consistently provides education to providers on self-help options/coding policies/new BlueCross programs etc.

7. Works effectively with team, other internal departments, attends committee meetings on behalf of team and establishes consistency in following up on internal requests/projects.

8. Has (or will develop) working knowledge of provider contracts, is able to address contract questions and fee schedule information on a regular basis and report potential issues to negotiator as needed.

Qualifications

Required Qualifications:

- Bachelor's Degree and 3 years of related work experience required, or 7 years of related work experience required in lieu of a degree.
- Familiarity with Microsoft Office products including, Word, Excel, and Access.
- Enhanced customer service skills.
- Time Management skills required.
- Organizational skills required.
- Problem-solving skills required.
- Some research skills necessary.

Preferred Qualifications:

- Baseline knowledge of STAR, PA&R, IMS or other internal systems preferred.

BlueCross BlueShield of MN is an Equal Opportunity and Affirmative Action Employer, M/F/D/V.

BlueCross BlueShield of MN is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Eagan
Shift: Day Job

Job Level: Experienced Professional]]>http://careers.bluecrossmn.com/job/Eagan-Network-Mgmt-Conslt-Job-MN-55120/1884974/188497418849742012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Summary:

This position is responsible for strategic direction and goals related to training, quality and continuous process improvement across the breadth of the service organization inclusive of back office operations, multi-channel consumer and provider technologies, capabilities and operations. Directs the implementation and maintenance of closed loop training and quality measurement process that proactively supports the performance of Service internal and external business teams. Identifies problems/opportunities and implements training and quality programs to correct or enhance employee and organizational performance.

Accountabilities:

1. Develop and implement an enhanced, comprehensive and sustainable training delivery model to support internal and external operations

2. Develop and implement a sustainable training and performance management model for all functional operations including but not limited to; claims multi-channel sales and service contact center, benefits & membership. Implementation of training class assessments, floor assessments, and employee certifications

3. Work collaboratively with service leadership and Sales to develop training strategies that support the operational and sales plans and coordinate requests for special training as need arises

4. Direct the proactive development of new training programs and the revision of existing training programs to ensure content meets business need and reflects the current state of health care

5. Lead the Service Division quality program through focused and comprehensive analysis of work flow and outcome. Direct training based initiatives that produce increased accuracy, productivity and mitigate error trends.

6. Collaborate with the business groups to develop, document and standardize standard procedures and workflow's to support achievement of operational quality

7. Leverage existing technology by identifying opportunities to systematize manual processes and interventions. Identify and present opportunities to incorporate new technology into processes and flows. Ensure that documentation and training follows

8. Oversee Knowledge Management content and application including policies, procedures and job aids. Ensures accurate and timely content management updates within the Knowledge Management tool.

9. Establish and maintain highly collaborative partnerships business teams and other areas such as HCM, IT, Sales, Internal Audit, and others that impact work performance.

Qualifications

Required Qualifications:

Accepting this director level position at BCBSMN requires signing an Agreement Regarding Non-Disclosure of Confidential Information and Non-Competition as a condition of employment

Bachelors degree 5 years experience with curriculum design, development and training delivery

7 years of management experience

Proven ability to identify and accommodate differences in learning styles across a diverse organization and functional understanding of scenario based learning strategies

Demonstrated knowledge and experience with electronic systems related to learning, content management, and/or knowledge management

High proficiency in quality analysis and trending for claims and calls center operations

Successful track record managing training and/or quality functions with process improvement implementation

7 years broad-based experience in call centers, claims operations, managed healthcare or related industry

Demonstrated ability to collaborate and influence others.

Demonstrated experience in achieving performance metrics.

Demonstrated analytical and problem-solving skills

Strong group and individual coaching skills

Preferred Qualifications:

Masters degree preferred

Training and or Quality Certifications or Professional Designations

Previous management experience within a call center and/or claims operation

Knowledge of state and federal regulations related to managed care industry

BlueCross BlueShield of MN is an Equal Opportunity and Affirmative Action Employer, M/F/D/V.BlueCross BlueShield of MN is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Eagan
Shift: Day Job]]>http://careers.bluecrossmn.com/job/Eagan-Dir-Training-Quality-&-Continuous-Improvement-Job-MN-55120/1884975/188497518849752012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Summary:

To provide executive level administrative support to BCBSM executives by performing a wide range of duties of a highly responsible and confidential nature.

Accountabilities:

1. Responsible for a variety of administrative duties to ensure the area runs smoothly and with appropriate confidentiality. These include: - Manage calendars and in-boxes for the executive() on a daily basis. Respond and forward messages with high level of professionalism - Create reports, documents, presentations, and spreadsheets while exercising independence regarding layout and style - Schedule meetings, conference rooms and travel arrangements - Anticipate needs of the executive() with minimal direction

2. Receives and screens telephone calls, letters, and/or visitors. Answers questions, sometimes of a more complex nature, obtains and furnishes information as appropriate.

3. Drafts correspondence for executives final approval

4. Anticipate needs and trouble shoots potential problems with minimal to no assistance or guidance

5. Ensures that the technology used in department meetings and presentations, including teleconferencing, mobile devices, laptops, etc. is completely mastered and can answer calls of assistance, set-up and troubleshooting.

6. Performs other duties as assigned.

Qualifications

Required Qualifications:

Associates degree and 5 years of related administrative experience or 7 years of related administrative experience in lieu of degree.

Pass a pre-employment test on Microsoft Office Demonstrates high level of interpersonal skills and professional acumen

Demonstrates high level of organizational skills

Demonstrates excellent communication and relationship building skills

Manages highly confidential information using appropriate discretion

Presents a highly professional, personable, and knowledgeable face to all internal and external contacts

Exercises a high level of judgment and timeliness in dealing with sensitive internal issues and relationships

Proficiency in written communication

Demonstrates ability to manage change and adapt work style and processes accordingly

Demonstrates acumen to understand the organization, policies and processes quickly

Exhibits competence in negotiating and dealing with customers and other stakeholders relative to redirecting them to other individuals

Manages multiple tasks in an environment of tight deadlines and quality standards Exhibits a high degree of autonomy and decision making discretion

Demonstrates advanced knowledge in Microsoft office tools (Excel, Word, PowerPoint Proficiency to learn other systems quickly Preferred Qualifications: CPS ( Certified Professional Secretary ) or CAP ( Certified Administrative Professional ) certification

BlueCross BlueShield of MN is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. BlueCross BlueShield of MN is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Eagan]]>http://careers.bluecrossmn.com/job/Eagan-Executive-Admin-Job-MN-55120/1888051/188805118880512012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Summary:

Responsible for working with business areas, project teams, and IT technical teams, as well as outsourced vendors to ensure high quality application support and delivery services. Maintains production stability and facilities. Manages resources, and mitigates risk through multiple environments. Provides code-level operational support, develops software, and coordinates maintenance and enhancement activity to support all aspects of application delivery. Focus is on new development for medium to large project work.

Accountabilities:

1. Supports and performs maintenance on new or existing software products, understanding application integration points and trouble shooting production problems.

2. Participates in conceptual design.

3. Contributes in the review of deliverables.

4. Works with technical staff to understand complex software problems involving many varied factors to be interpreted and considered, frequently of moderate to high scope.

5. Participates as a highly technical expert in design, development, coding, testing, and debugging new software or making significant enhancements to existing software.

6. Assists project manager in developing estimates and technology requirements.

7. Resolves customer complaints with software and initiates or responds to suggestions for improvements and enhancements.

8. May participate in user groups and provide recommendations for standards and guidelines.

9. Is engaged in root cause analysis as it relates to either the application or the product. Assists with sizing efforts.

10. Provides direction to others by acting as a guide or mentor.

11. Works closely with customers and technical and team members to understand business requirements that drive the analysis and quality technical solutions.

12. Prepares detailed specifications from which programs will be written to develop or modify large complex software applications.

13. Writes documentation to describe program development, logic, coding and corrections.

14. Assists in the development of software user manuals and/or demonstrates software. Serves as an application functionality and technical construction subject matter expert.

15. Consults with business areas and IT technical resources regarding system scope, objectives, integration and solutions based on user needs.

16. May assist in hiring process by conducting technical interviews. May assist in the development of Service Level Agreements.

Qualifications

Required Qualifications:

- Bachelors degree in Computer Science or related field and a minimum of 4 years of related experience. If no degree, than a minimum of 8 years of related experience

- Demonstrated ability to develop/design programs of moderate complexity In-depth/extensive technical, business, industry knowledge

- Excellent analytical, PC and problem solving skills.

- Excellent oral and written communication and presentation skills
- Demonstrated human relations skills to effectively interact with management, peers, and internal/external vendors.

- Demonstrated understanding of the standards and deliverables to ensure integrity of the development process.

- Demonstrated in-depth knowledge of internal area applications.
- Demonstrated ability to influence and motivate individuals and teams
- Demonstrated ability to utilize extensive interpretation and judgment, develop new methods and procedures.

Preferred Qualifications:

- In-depth knowledge of BCBS computer methodologies General knowledge of many BCBS business areas.

- In-depth knowledge of one or more business areas Technical Certification
- Participation in user groups (ACM, IEEE)

BlueCross BlueShield of MN is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. BlueCross BlueShield of MN is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Eagan]]>http://careers.bluecrossmn.com/job/Eagan-Software-Developer-Sr-Job-MN-55120/1888052/188805218880522012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Summary:

This position primarily collaborates with business partners across operations and manages business objectives and readiness. This position will work with the business owner and cross-functional teams to manage the deployment of business relation activities that span multiple departments. This position will provide work direction to the stakeholders participating on the work effort. This position reports to Business Support Services.

Accountabilities:

Primarily manage the implementation of operational related projects through the application of project management, meeting management and group facilitation skills.

Collaborate with business stakeholders to identify project objectives and manage business readiness activities (communication plans, training plans, benefits etc.) in order to realize the desired business outcome.

Manage the development of both business solutions and application solutions, focusing on both the business implications of technology and the technology on the business.

Lead and complete business impact analysis assessments.

Develop and maintain standardized methods of implementation to ensure a consistent and integrated customer experience.

Qualifications

Required Qualifications:

Bachelor’ degree in Business or related field or equivalent work experience. 5 years experience in project management or consulting experience.

Demonstrated organizational relationship management skills.

Strong problem solving skills, conflict resolution, facilitation and negotiation skills. Excellent written and verbal communication skills.

Self-motivated, ability to work independently, and demonstrated ability to work under tight timeframes.

Strong personal computing skills with emphasis on Word, PowerPoint, Excel and MS Project.

Preferred Qualifications:

Experience with development of formal business processes and methodologies. Proven ability to handle a variety of assignments

BlueCross BlueShield of MN is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. BlueCross BlueShield of MN is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Eagan]]>http://careers.bluecrossmn.com/job/Eagan-Business-Implementation-Lead-Sr-Job-MN-55120/1888053/188805318880532012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Job Summary:

This highly critical position is responsible for leadership and management of the entire Technology Operations organization, which is comprised of 1) a primary 24x7 data center, its operation and its support team, 2) a secondary 24x7 self recovery data center and its operation, 3) the production control, enterprise scheduling, and software configuration management team, and 4) the digital print, offset graphics, and mail/fulfillment team. It is also responsible for planning and implementing short- and long-term technology strategies, tactics, implementation work plans and projects to ensure continuous stability of the enterprise-processing environment. Provides problem management determination and resolution information for all of the company's business critical systems. Develops and manages a staff of 120 that includes exempt professional, non-exempt, managerial, supervisory, technical, and clerical staff.

Accountabilities:

1. Develop, plan, and direct the daily operation of the three tiers of computing systems and the physical technical infrastructure across the enterprise to support and enable stable business activities for ¨25,000 square feet of data center space¨3 mainframe systems¨250 UNIX distributed systems¨200 Wintel LAN server systems¨50 Terabytes of data storage¨120 staff

2. Lead and influence development of IS operational policies, practices, and processes to ensure effective maintenance, delivery, accountability, adherence to HIPAA, SAS70, Sarbanes-Oxley business rules, and the integrity of corporate information systems.

3. Develop, forecast, and monitor physical resources budgets for the enterprise hardware and software maintenance environment in conjunction with IS Finance and Technology Infrastructure leadership. This budget is $25M+.

4. Develop, forecast, and monitor the staff resources operational budgets of $3M.

5. Develop the KRAs, performance reviews, and skills training for the staff that leads to a high performance staff.

6. Define vendor maintenance support requirements and contracts, establish vendor relationships, and provide ongoing oversight of vendor maintenance delivery.

7. Maintain efficient and cost effective operation of a top tier, in-plant print operation and mail / fulfillment center which produces and processes business critical documents and marketing material for the corporation.

8. Manages the department including interviewing and hiring employees following required EEO and Affirmative Action guidelines and ensuring employees receive the proper training. Conducts performance evaluation, and is responsible for managing employees, including skill and career development, policy administration, coaching on performance management and behavior, employee relations and cost control.

Qualifications

Required Qualifications:

1.
Accepting this director level position at Blue Cross requires signing an Agreement Regarding Non-Disclosure of Confidential Information and Non-Competition as a condition of employment.

2.
Extensive experience in the integration of business workflow and the technology that supports it.

3.
An advanced understanding of computing and the technologies and services that enable it.

4.
Experience in supporting a medium to large sized multi-platform processing environment

5.
An understanding of data center physical infrastructure and environmental controls.

6.
An understanding of infrastructure monitoring frameworks and automation processes.

7.
Broad understanding of insurance and information technology industries.

8.
Excellent experience in project management skills for infrastructure.

9.
Broad knowledge of current and emerging technologies and how they can be applied to solve business problems; ability to deal with technical detail without necessarily having deep expertise/vertical knowledge in all aspects of a given technology.

10.
Understanding of industry trends, best practices especially with respect to enterprise computing, data center operations, digital print, and software configuration management.

11.
Ability to leverage resources, both internal and external, to create technology solutions to meet the needs of BCBSMN

12.
Ability to effectively communicate about architectures with technicians.

13.
Ability to balance tactical needs and business realities with strategic requirements.

14.
Organizational effectiveness - sought out by others; influences results; seen as a solution provider.

15.
Excellent customer marketing, relationship management skills; ability to communicate about technology in terms that are meaningful to the business; excellent presentation skills.

16.
Ability to generate options for migrating to strategic architectures.

17.
Vendor relationships - ability to manage partners, influence providers.Controlling administrative and capital expenses by effectively planning for the utilization of staff, equipment, and budgeted funds.

18.
10%-20% travel may be required

19.
Proven history of developing exceptional staff capabilities.

20.
Proven project and people management skills.

21.
Ability to continuously prioritize the operational demands to meet and exceed business expectations.

22.
Excellent communication skills, both written and oral. Must be able to effectively communicate to a broad spectrum of people, from operator trainees to company officers (key element).

23.
Advanced presentation/PC skills.

24.
Ability to thrive in a fast paced, exacting environment. Proficiency at quickly assimilating and analyzing large amounts of data, solving problems.

Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action Employer, M/F/D/V.Blue Cross and Blue Shield of Minnesota is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

J2W:DIC

Primary Location: United States-Minnesota-Eagan
Shift: Day Job

Job Level: Director]]>http://careers.bluecrossmn.com/job/Eagan-Director-Technology-Operations-Job-MN-55120/1888055/188805518880552012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Summary:
This position offers a technical track with a focus on programming, or an analytical track with a focus on gathering, analyzing and interpreting. The incumbent both works independently and guides teams which initiate, plan, and lead analysis from conceptual development to program implementation.

This position is responsible for obtaining data from various internal sources, understanding relevant differences between each data source, and designing/creating database structures for analysis and possible production reporting. In addition, the incumbent must be able to perform validation techniques, as well as perform and interpret a variety of statistical analyses. The position will work closely with coworkers to change/develop current systems for improved decision making, and help support others in the creation, development, and testing of new models.

This position manages complex data and information to provide meaningful results, identifying success factors and improvement opportunities, suggesting potential solutions, and helping internal customers set strategic directions.

In addition, a Principal level represents Informatics on various internal and external initiatives. They may also lead project teams. The incumbent will lead efforts to define meaningful contributions that will influence strategic decision-making at Blue Cross Blue Shield of Minnesota.

Accountabilities:
1. Modifies necessary databases for analysis and dissemination of information.
2. Performs complex analysis of the data. Researches, analyzes and interprets statistical data and provides technical assistance to other departments. Identifies issues to be researched, determining affected areas, estimating the impact and leading the resolution.
3. Leads team(s) to develop measurement plans, analyze data, and report results on health care utilization, expenditures, outcomes, and benchmarks.
4. Initiates action to discover new analysis or programming that will contribute to the: (1) continuous growth of the Health Economics department, and (2) ability of the department to play a more strategic role in meeting customer needs.
5. Works with senior positions or management to understand and interpret the financial impact of decisions made by retrieving and analyzing claim costs, revenue and/or other relevant data.
6. Participates in the implementation of new products and system enhancements by providing data and recommendations to assist in evaluating the impact of the proposed benefit, system or process changes.
7. Represents the division on corporate projects and may have leadership roles on these teams.
8. Independently manages the retrieval and analysis of data, and issues that may arise on multiple tasks or projects with little or no management involvement.
9. Acts as a resource and/or mentor for other members of the department/division on business issues and may be responsible for training and guidance of other employees.
10. Formulates strategic recommendations and present findings to management and external clients.
11. Leads analysis of projects relating to claims, clinical quality, disease management, and provider network projects.
12. Serves as a measurement or analytic consultant who can explain complex measurement or analysis techniques and results in layman’s terms.

Qualifications

Required Qualifications:
Bachelor's degree in related field and 5 years of relevant work experience
5 years experience analyzing and modeling data involving outcomes and utilization, using varous statistical software and computer programming (SAS, Visual Basic, DB2, Oracle, etc.)
Proficiency in Microsoft software applications such as Word, PowerPoint, Excel, Access.
Demonstrated ability to design, evaluate and interpret complex data sets
Demonstrated ability to handle multiple tasks with competing priorities
Demonstrated analytic and problems solving skills
Excellent written and verbal communication skills, with the ability to interpret and communicate analytical information to both individuals and groups in a clear and concise manner
Demonstrated ability to present complex technical information to non-technical audiences and to senior decision-makers
Demonstrated ability to work effectively both independently and in a team setting with individuals having diverse professional backgrounds including business, technical and/clinica
Preferred Qualifications:
Masters degree preferred
Knowledge of managed care and healthcare claims preferred

BlueCross BlueShield of MN is an Equal Opportunity and Affirmative Action Employer, M/F/D/V.
BlueCross BlueShield of MN is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Eagan]]>http://careers.bluecrossmn.com/job/Eagan-Healthcare-Analyst-Pr-Job-MN-55120/1890906/189090618909062012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US
Description

Summary:

This position offers a technical track with a focus on programming, or an analytical track with a focus on gathering, analyzing and interpreting. The incumbent both works independently and guides teams which initiate, plan, and lead analysis from conceptual development to program implementation. This position is responsible for obtaining data from various internal sources, understanding relevant differences between each data source, and designing/creating database structures for analysis and possible production reporting. In addition, the incumbent must be able to perform validation techniques, as well as perform and interpret a variety of statistical analyses. The position will work closely with coworkers to change/develop current systems for improved decision making, and help support others in the creation, development, and testing of new models. This position manages complex data and information to provide meaningful results, identifying success factors and improvement opportunities, suggesting potential solutions, and helping internal customers set strategic directions. In addition, a Principal level represents health economics on various internal and external initiatives. They may also lead project teams. The incumbent will lead efforts to define meaningful contributions that will influence strategic decision-making at Blue Cross Blue Shield of Minnesota.

Accountabilities:

1. Modifies necessary databases for analysis and dissemination of information.

2. Performs complex analysis of the data. Researches, analyzes and interprets statistical data and provides technical assistance to other departments. Identifies issues to be researched, determining affected areas, estimating the impact and leading the resolution.

3. Leads team(s) to develop measurement plans, analyze data, and report results on health care utilization, expenditures, outcomes, and benchmarks.

4. Initiates action to discover new analysis or programming that will contribute to the: (1) continuous growth of the Health Economics department, and (2) ability of the department to play a more strategic role in meeting customer needs.

5. Works with senior positions or management to understand and interpret the financial impact of decisions made by retrieving and analyzing claim costs, revenue and/or other relevant data.

6. Participates in the implementation of new products and system enhancements by providing data and recommendations to assist in evaluating the impact of the proposed benefit, system or process changes.

7. Represents the division on corporate projects and may have leadership roles on these teams.

8. Independently manages the retrieval and analysis of data, and issues that may arise on multiple tasks or projects with little or no management involvement.

9. Acts as a resource and/or mentor for other members of the department/division on business issues and may be responsible for training and guidance of other employees.

10. Formulates strategic recommendations and present findings to management and external clients.

11. Leads analysis of projects relating to claims, clinical quality, disease management, and provider network projects.

12. Serves as a measurement or analytic consultant who can explain complex measurement or analysis techniques and results in layman’s terms.

Qualifications

Required Qualifications:

1.
Bachelor's degree in related field and 5 years of relevant work experience

2.
5 years experience analyzing and modeling data involving outcomes and utilization, using varous statistical software and computer programming (SAS, Visual Basic, DB2, Oracle, etc.)

3.
Proficiency in Microsoft software applications such as Word, PowerPoint, Excel, Access.

4.
Demonstrated ability to design, evaluate and interpret complex data sets Demonstrated ability to handle multiple tasks with competing priorities Demonstrated analytic and problems solving skills

5.
Excellent written and verbal communication skills, with the ability to interpret and communicate analytical information to both individuals and groups in a clear and concise manner

6.
Demonstrated ability to present complex technical information to non-technical audiences and to senior decision-makers

7.
Demonstrated ability to work effectively both independently and in a team setting with individuals having diverse professional backgrounds including business, technical and/clinical

Preferred Qualifications:

1.
Masters degree

2.
Knowledge of managed care and healthcare claims

BlueCross BlueShield of MN is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. BlueCross BlueShield of MN is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.

Primary Location: United States-Minnesota-Eagan]]>http://careers.bluecrossmn.com/job/Eagan-Healthcare-Analyst-Principle-Job-MN-55120/1894281/189428118942812012-06-14Blue Cross Blue Shield of Minnesotafull-timeUSDstarting0BSEagan, MN, US