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As an IT Project Manager, you will coordinate project planning and execution, monitor progress, manage resources, and ensure compliance with project standards while leading multiple low complexity projects.
The Representative, Enrollment I is responsible for processing membership and enrollment applications, handling terminations and renewals, updating databases, and addressing customer inquiries. This role involves working with various operational areas, preparing contracts and ID cards, and participating in enrollment-related projects.
The Provider Contracting Manager is responsible for establishing and maintaining provider networks, managing contract negotiations, ensuring compliance with contract obligations, and conducting financial analyses of contract proposals. This role requires effective relationship management with providers and coordination with internal departments to improve operational processes and training programs.
The Provider Enrollment Analyst is responsible for reviewing, researching, analyzing, and processing provider enrollment applications, ensuring compliance and integrity of provider data. Key tasks include data entry, providing customer service, resolving discrepancies, and supporting process improvements and special projects.
The Strategic Account Executive is responsible for sales, service, and management of relationships with existing and prospective accounts, including analyzing data and market trends, mentoring team members, and managing new account sales strategies.
The Provider File Specialist I is responsible for maintaining healthcare provider files, ensuring accurate provider directories, claims adjudication, and billing processes. This role involves verifying information, preparing and managing provider data in relevant systems, and participating in special projects related to quality improvement and audits.
The Auditor III will conduct various operational, financial, and compliance audits, evaluate internal controls, identify business risks, prepare audit reports, and provide training to other auditors. Additionally, the role involves developing audit programs and maintaining data integrity in financial systems.
The Group Actuary Manager oversees actuaries, ensuring accurate actuarial reporting and analysis. They direct the preparation of reports, conduct profitability analysis, review rating bureau changes, and ensure compliance with regulatory submissions. They also manage hiring, coaching, and staff performance while supporting the development of actuarial models.
The Quality Assurance Analyst performs audits and monitoring of departmental operations to ensure quality standards. Responsibilities include identifying problems, analyzing causes, generating reports, coaching new hires, and recommending improvements. The role focuses on claims, customer service, and operational efficiency.
Supervise and manage SOX/MAR compliance activities across BCBSSC companies. Responsibilities include developing policies for compliance, conducting risk assessments, documenting key controls, and ensuring the effectiveness of the compliance program while providing leadership and guidance to staff.
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