Claims Vendor Integration Analyst

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

This position is eligible for the Flex persona.

Key Accountabilities:

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

Education and Experience:

• BA/BS degree in business, healthcare or related experience
• 3-5 years of analytical, process improvement, or audit experience with claims processing and/or vendor integration required.
• Excellent verbal and written communication skills; strong business writing skills required.
• Demonstrated meeting facilitation and requirement solicitation skills (required)
• Proficiency in Microsoft office, specifically MS Outlook, MS Excel, MS Word required.
• Strong understanding of BCBSMA core processing systems (OLB, NASCO and RTMS) required.
• Proficiency with identifying and drafting business requirements required.
• Demonstrated experience in building tools to track and manage open issues to develop Technical and or operational corrective action plans required.
• Experience with planning, coordinating, and performing post-production validation required.
• Demonstrated the ability to self-learn new tools and processes (required)
• Ability to work both independently and in a matrix environment required.
• MS Visio, MS Power Point, and AMS experience strongly preferred.
• Understanding of vendor integration and vendor integration tools (Accum Connect, EAVR, MAX, MAT) strongly preferred.
• Data Warehouse reporting experience strongly preferred.
• Knowledge of BCBSMA's JIRA and CSR process is strongly preferred.
• Understanding of the Defect Management process is strongly preferred.
• Previous experience in reconciling account and member data using corporate source systems (Data Warehouse, NASCO, RTMS, etc.) preferred.

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High school degree or equivalent required unless otherwise noted above

The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee's pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.

This job is also eligible for variable pay.

We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

WHY Blue Cross Blue Shield of MA?

We understand that theconfidence gapandimposter syndromecan prevent amazing candidates coming our way, so please don't hesitate to apply. We'd love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It's in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.

As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting ourCompany Culturepage. If this sounds like something you'd like to be a part of, we'd love to hear from you. You can also join ourTalent Communityto stay "in the know" on all things Blue.

At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our "How We Work" Page.