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Job DescriptionIT is different here. Our work as technology specialists pushes the boundaries of what’s possible in health care. You will build solutions that make a real difference in people’s lives. Driven by the importance of their work, our team members innovate to elevate. We’re encouraged to be curious, collaborate, and turn ideas into solutions that can make health care better for all.In this role you will serve as a consultative partner to customers, working end to end to and bringing deep business knowledge to understand problems, design and complete analyses appropriate the problem and translate insights to action. Lead our efforts in reducing medical expense and combatting Fraud, Waste & Abuse alongside our Payment Integrity group.If you are ready to make a career out of making a difference, then you are the person for this team.What You Will Do
Monitor and perform in-depth analysis of data for customers to determine areas of improvement or where investigation is needed.
Identify complex data problems and issues and is responsible for resolution.
Identify complex trends and make recommendations to business areas to effectively assist them with decision making on operational or other business issues.
Communicate meaningful insights by creating charts and slide presentations and presenting findings to all levels of leadership staff.
Maintain and coordinate existing cross-functional programs, and create and develop new programs.
Support and manage complex applications systems on many platforms and manage code migrations and changes between different applications environments.
Develop, maintain, and monitor reports on system security to ensure user access is appropriate for the specific division. Provide ongoing user support for ad hoc reporting, questions, queries, and problem support
Ensure appropriate security and privacy for all data that contains PHI fields. Resolve all security and privacy issues in the data.
Represent department on large enterprise project teams and process optimization efforts as needed.
Serve as a mentor/coach for less experienced employees.
What You Bring
Bachelor's degree or advanced degree (where required)
8+ years of experience in related field.
In lieu of degree, 10+ years of experience in related field.
SQL expertise
Strong preference for experience in Healthcare domain with a focus on Payment Integrity, fraud, waste and abuse.
Salary Range$91,100.00 - $164,000.00About UsIt's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians.Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all.Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.Authorization to Work in the United StatesWe use E-verify to confirm authorization to work in the United States. To learn more about E-Verify, including your rights and responsibilities, please visit E-Verify Overview (https://www.e-verify.gov/employees/e-verify-overview) for English or Visión General de E-Verify (https://www.e-verify.gov/es/empleados/vision-general-de-e-verify) for Español.For most roles, you can choose where to work - fully remote in one of the states listed below, in the office, or a hybrid of the two:Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and WyomingMuch more than a paycheckThe total value of working at Blue Cross NC goes far beyond your paycheck. We offer benefits and perks (https://careers.bluecrossnc.com/global/en/benefits) that help you thrive, such as competitive health benefits, bonus plans based on performance, 401(k) with employer match, paid time off (plus two well-being days), and a variety of career development and wellness programs.