Blue Cross Blue Shield

As a nonprofit health plan, Blue Shield of California is guided by our mission and values, which encourage innovation and focus our efforts on transforming the current healthcare system into one that is worthy of our family and friends.

Blue Cross Blue Shield Redding, CA, USA
Jan 07, 2020
Full time
At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. We’re excited to share Blue Shield of California has received awards and recognition for – LGBT diversity, quality improvement, most influential women in corporate America, Bay Area’s top companies in volunteering & giving, and one of the world’s most ethical companies. Here at Blue Shield of California, we’re striving to make a positive change across our industry and the communities we live in – Join us!   Description   Essential Responsibilities: Able to perform all lower level responsibilities. Handles all aspects of inventory reduction, including various correspondence. Assists with systems testing. Provides training support for live calls. Handles escalated calls that are not able to be de-escalated by the Intermediate Customer Service Representative. Resolves complex pharmacy questions. Execution of prior authorization requests. Ability to perform back-end claims processing using knowledge of system applications and documented workflows to resolve edits accurately. Proficient in resolving complex claims edits using available documents/job aids with minimum direction when performing back-end processing. Responsible for special processing assignments; coordinates with Medical Management. Pharmacy Services, Claims, and Installation and Billing if needed. Ability to perform complex adjustments. Other duties as assigned.   Organizational Impact: Works to deliver day-to-day objectives with significant impact on achievement of results for the job area. Work consists of tasks that may not be typically routine. Works independently under limited supervision. May be required to apply discretion within broad operational boundaries and procedures.   Innovation & Complexity: Responsible for making minor changes in systems and processes to solve problems or improve effectiveness of job area. Expected to independently propose solutions to problems for manager review. Problems and issues faced are general, and may require some analysis to understand and resolve.   Communication and Influence: Communicates with contacts typically within and outside the job area on matters that involve obtaining or providing information on matters of moderate importance to the job area. Explains practices, procedures and policies to reach agreement.   Leadership & Talent Management: Responsible for providing guidance, coaching and training to other employees within job area.     Qualifications   Knowledge & Experience: For bilingual jobs, Spanish language proficiency as demonstrated by successful completion of an oral language proficiency test. Requires broad knowledge of operational systems and practices typically gained through extensive experience and/or education. Typically, requires minimum of 5 years of experience. May require vocational or technical education in addition to prior work experience. Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork – Activity level:   Sedentary, frequency most of work day.   Physical Requirements   Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork – Activity level: Sedentary, frequency most of work day. Please click here for further physical requirement detail.     Job :   Member Services Primary Location :   United States of America-California-Redding Organization :   Customer Experience Schedule :   Full-time             James
Blue Cross Blue Shield Woodland Hills, Los Angeles, CA, USA
Jan 07, 2020
Full time
At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. We’re excited to share Blue Shield of California has received awards and recognition for – LGBT diversity, quality improvement, most influential women in corporate America, Bay Area’s top companies in volunteering & giving, and one of the world’s most ethical companies. Here at Blue Shield of California, we’re striving to make a positive change across our industry and the communities we live in – Join us!   Description   Actuarial Operations Responsible for pricing, risk management, reserving, forecasting, trend setting and actuarial administration including conducting analysis, monitoring, evaluating, and reporting of the effectiveness of rating formula and participating in the development of new products.   Actuarial Analyst Provides Actuarial department with pricing support, calculating reserves, risk assessment/analysis, data reporting, financial forecasting/projections, creating filings and/or performing financial and risk analysis in changes to provider contracts to help meet company goals of providing low-cost healthcare and meeting earnings objectives.   Essential Responsibilities: • May perform a combination of the following depending on discipline/dept. • Understands the core principles of decision analytics, with knowledge of the analytic tools and techniques that are used to acquire and analyze data for reporting and decision making used for decision analytics. • Can understand, update, and run programs that applies to decision analytic techniques. • Has gained a basic understanding of claim, premium, membership and/or risk score assignment data. • Learns various actuarial techniques and procedures to conduct analysis, assess risk and population risk scores and assignment, develop pricing and trends, assess changes in benefit designs, develop reserves, perform forecasting, analyze provider reimbursement terms and/or evaluates actuarial risk related analysis. • Compiles and categorizes data, documenting and verifying the factors used in computations such as those used in evaluating loss and expense reserves, preparing rate filings, schedules of statistics, premiums, benefits, member risk data and score submissions and establishing rating and pricing levels. • Produces timely various standard analytic reports for internal and/or external use. Other duties as assigned.     Qualifications   • Requires BS degree in mathematics, statistics, computer science or related discipline and/or equivalent business experience. • Typically, has completed 1 to 2 courses towards the eventual attainment of the Associate, Society of Actuaries (ASA) designation. • No previous professional actuarial experience required but typically has obtained broad theoretical job knowledge through advanced education.     Physical Requirements   Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork – Activity level: Sedentary, frequency most of work day. Please click here for further physical requirement detail.     Job :   Actuarial Operations Primary Location :   United States of America-California-El Segundo Other Locations :   United States of America-California-Woodland Hills Organization :   Finance Schedule :   Full-time             James
Blue Cross Blue Shield Woodland Hills, Los Angeles, CA, USA
Jan 07, 2020
Full time
At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. We’re excited to share Blue Shield of California has received awards and recognition for – LGBT diversity, quality improvement, most influential women in corporate America, Bay Area’s top companies in volunteering & giving, and one of the world’s most ethical companies. Here at Blue Shield of California, we’re striving to make a positive change across our industry and the communities we live in – Join us!   Description   Clerical Services Performs routine organization, administration, and documentation tasks.   Clerical Support Provides key support for functional groups, including performance of a wide variety of specialized clerical functions Resolves discrepancies and may communicate with a variety of administrative and professional employees within and outside the organization.   Essential Responsibilities: Provides basic clerical services for a variety of functions. Services would include batching, tracking, compiling and distributing mail, proofreading and assembly of documents in addition to general office support such as faxing, filing, and copying. Answering and directing phone calls. Receiving, sorting and distributing incoming mail. Maintaining filing systems. Photocopying, scanning and faxing. Preparing and sending outgoing mailings and packages Use various software and systems to accomplish work Other duties as assigned.     Qualifications   Requires limited job knowledge of systems and procedures. Follows basic work routines and standards. Typically, has limited or no prior experience.   Physical Requirements   Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork – Activity level: Sedentary, frequency most of work day. Please click here for further physical requirement detail.     Job :   Administrative Services Primary Location :   United States of America-California-Woodland Hills Organization :   Customer Experience Schedule :   Full-time             James
Blue Cross Blue Shield Lodi, CA, USA
Jan 07, 2020
Full time
At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. We’re excited to share Blue Shield of California has received awards and recognition for – LGBT diversity, quality improvement, most influential women in corporate America, Bay Area’s top companies in volunteering & giving, and one of the world’s most ethical companies. Here at Blue Shield of California, we’re striving to make a positive change across our industry and the communities we live in – Join us!   Description   Description : Services Producers, Group Administrators, and our internal sales team by addressing inquiries through different channels (e.g., live web-based applications, telephone and email), resolving issues, and educating inquirers. Ensures complex issues are properly handled in accordance with Priority procedures. Networking across internal departments to reach resolution resulting int timely, well communicated responses. Correspondence/Phone Support: Responds to and resolves various customer inquiries via telephone, email, and correspondence, and resolves claims problems within established production and quality standards. Answers incoming calls and written requests for information from producers, sales, and group admins promptly and accurately. Composes routine and non-routine correspondence to answer inquiries that require a written response. Coordinates with other departments to ensure timely and appropriate responses. Expedites and resolves complex issues. Educates others on the Blue Shield product, providing accurate information and updates to policies and procedures, improving overall customer satisfaction. Capable of effectively navigating through multiple platforms or applications to efficiently locate information and complete processing tasks.   Essential Responsibilities:   Support -Responds to producers, group administrators, and our internal sales, expedite, research, and resolve complex issues. Inventory Control-  Oversee aged cases, report stats and information, inventory reduction, routine to mid-level Be Approachable-  Always available to assist, positive attitude, A leader must remain focused on aiding in a positive way, so agents feel we are there for them and they feel supported. Communication-  Advise of identified call drivers, assist with team meeting agenda, Open communication, participates in a relationship with a solid foundation of trust, sincere and willing to learn and share personal best practices, Open receiving and applying to feedback Dependability-  At Blue Shield, punctuality and regular attendance are particularly important and are a critical part of fulfilling employee expectations and meeting business objectives. As a leader within Blue Shield it is important to support and exemplify our culture of dependability by holding yourself accountable to ensure the representatives develop sustainable success through continuous and timely mentoring and/or coaching Live by Blue Shield values-  Trusted and Trusting, Valuing People, Results Oriented, Agile and Nimble, Interconnected, Creative Solutioning, Customer Centric Preferred Knowledge:   Strong written and verbal communication, along with the ability to coach IFP Product knowledge, claims, and adjustments Be comfortable with all systems representatives use, have job knowledge of procedures/processes obtained through prior work experience or education. Bilingual in Mandarin and Cantonese - able to communicate effectively both written and verbally       Qualifications   Knowledge & Experience: For bilingual jobs, Spanish language proficiency as demonstrated by successful completion of an oral language proficiency test. Requires broad knowledge of operational systems and practices typically gained through extensive experience and/or education. Typically, requires minimum of 5 years of experience. May require vocational or technical education in addition to prior work experience. Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork – Activity level:   Sedentary, frequency most of work day.   Physical Requirements   Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork – Activity level: Sedentary, frequency most of work day. Please click here for further physical requirement detail.     Job :   Member Services Primary Location :   United States of America-California-Lodi Organization :   Customer Experience Schedule :   Full-time         James
Blue Cross Blue Shield Rancho Cordova, CA, USA
Jan 07, 2020
Full time
Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of California is focused on transforming health care by making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 3.5 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution. We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. Come and help us make health care better for everyone.  Description   The Blue Shield of California (BSC) Investigator reports to SIU Management and has the duty and responsibility to support and conduct investigations in either a proactive or reactive manner. The Investigator must represent a high level of professionalism both internally and externally, possess strong time management skills and able to work effectively without direct supervision. The incumbent will initiate, analyze, develop and successfully complete investigations and support other team members as needed. Investigations will be conducted in accordance with company policies and procedures and in compliance with all applicable laws and regulations.   The incumbent will be responsible for supporting and coordinating efforts to recover erroneous payments made as a result of a claims processing error, misrepresentative billing, fraud, abuse or any other criminal act. Ability to travel as required, including occasional overnight stays.   Responsibilities:   Manage investigative case load while performing multiple duties. Assist with prepayment review of claims in Special Investigations Unit across multiple lines of business. Obtain data from multiple internal systems in response to Requests for Information (RFIs) from law enforcement and health plan oversight agencies. Perform quality work duties concurrently by prioritizing to meet deadlines. Collect and preserve detailed information. Document all stages of each investigation using Company and department procedures, templates and form. Prepare detailed post-audit investigative reports. Maintain in-depth working knowledge of auditing, coding, and investigative techniques. Develop and maintain collaborative relationships with BCBSA, BCBS Plans and other carriers’ audit anti-fraud professionals. Handle highly confidential and sensitive information while ensuring compliance with the Company’s privacy policies. Participate on special projects as assigned. Attend appropriate educational opportunities (BCBSA, NHCAA, AAPC and ACFE) to keep apprised of developments in health care fraud.     Qualifications       Previous investigative experience required, healthcare fraud experience preferred. Extensive knowledge of multiple BlueShield claims and customer service systems including TPSU, NASCO and Facets preferred. Excellent written, oral and interpersonal skills. Must be detail oriented. Required proficiency in Microsoft Excel and Word. Business Objects experience preferred; SAS experience a plus. Ability to handle highly confidential and sensitive information while ensuring compliance with Company’s privacy policies. Experience with report writing and business correspondence. Analytical ability to identify problems, develop solutions and implement a chosen course of action. Ability to coordinate activities with varying levels of management, staff, external agencies and medical professionals through strong verbal and written communications. Demonstrated maturity and tact, with the ability to be diplomatic and persuasive in situations requiring those qualities. Demonstrated ability to work independently, yet function within team and corporate structure. Ability to prioritize and practice excellent time management skills. Ability to maintain organization in all aspects of job. Ability to travel as required, including occasional overnight stays. Ability to tolerate stressful and/or confrontational situations and maintain composure. Ability to work flexible work schedules to accommodate investigations scheduling and completion. Bachelor’s degree in business or health related field plus knowledge of medical terminology and anatomy preferred. Must have a valid driver’s license and a good driving record as well as use of an automobile that is properly licensed and insured pursuant to all legal requirements. Additional Qualifications Preferred: o   AHFI, CFE, CPC. o   Bilingual skills.   Physical Requirements   Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork – Activity level: Sedentary, frequency most of work day. Please click here for further physical requirement detail.    Job :  Special Investigations Unit Primary Location :  United States of America-California-Rancho Cordova Organization :  Law Schedule :  Full-time       James