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Business Analyst, Consultant
Blue Shield of CA
-
Oakland, CA / Long Beach, CA / El Dorado Hills, CA / 3 more...
Your Role The Blue Shield of California Promise Health Plan Clinical Access Programs department is responsible for regulatory oversight and audits of providers to ensure the quality of care and services received by our members, monitoring and oversight of access and availability of care, and member outreach and coordination of care. The Business Analyst, Consultant will r
Email Job
Posted 2 days ago
Business Analyst, Experienced
Blue Shield of CA
-
El Dorado Hills, CA / Lodi, CA / Rancho Cordova, CA
Your Role The Installation and Billing (I&B) team within Blue Shield of California oversees the enrollment, billing and payments process for their groups and members. The Experienced Business Analyst will report to the Manager of Programs and Projects. In this role you will drive the facilitation, management and analysis of incidents related to enrollment, billing, and in
Email Job
Posted 3 days ago
Sr. Manager, Contracting
Blue Shield of CA
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Oakland, CA / Long Beach, CA / El Dorado Hills, CA / 3 more...
Your Role The Global Business Services (GBS) department is responsible for delivering strategic and category supplier sourcing, contracting and governance excellence at Blue Shield of California. The Senior Manager, Procurement Contracting role will report to the Director, Contracting. In this role you will be responsible for the management, prioritization and execution o
Email Job
Posted 3 days ago
Case Management - Nurse, Senior
Blue Shield of CA
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Rancho Cordova, CA / Oakland, CA / Long Beach, CA / 4 more...
Your Role The Case Management team performs and case management (CM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members care including clinical nurses and treating MDs. . The Case Management Nurse, Senior will report to the Manager, Care Management. In this role you will determine, develop and im
Email Job
Posted 3 days ago
Correspondence Phone Support, Intermediate
Blue Shield of CA
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Rancho Cordova, CA / Oakland, CA / Long Beach, CA / 4 more...
Our Customer Experience Teams receive incoming telephone calls from our members. Our Call Centers are open 7 days a week. If hired, you will be required to attend and complete a paid, mandatory training. Training will be held in a remote environment. Remote training requires secure, reliable internet connectivity. Any hybrid work or training requires both remote and on pr
Email Job
Posted 3 days ago
Business Systems Analyst, Consultant
Blue Shield of CA
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Oakland, CA / Long Beach, CA / El Dorado Hills, CA / 4 more...
Your Role The Law Business team brings experience, expertise and solutions in technology, data management and other support services to help the Law Department continuously improve and excel in our support of BSC and its affiliates. The Business Analyst will be responsible for providing technical support to the Law Department teams and will report to the Law Business Team
Email Job
Posted 3 days ago
Business Analyst, Senior - Regulatory Medi-Cal
Blue Shield of CA
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Oakland, CA / Long Beach, CA / El Dorado Hills, CA / 3 more...
Your Role The Medi Cal Program Support (MPS) team ensures sufficient and complete Medi Cal operational documentation by reviewing and supporting development of business process documentation; development of regulatory data and files process documentation; and development of employee trainings. The Business Analyst will report to the Senior Manager of the Business Process
Email Job
Posted 3 days ago
Special Investigations Investigator, Consultant
Blue Shield of CA
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Oakland, CA / Long Beach, CA / El Dorado Hills, CA / 3 more...
Your Role The Special Investigations Unit team is responsible for preventing, detecting, investigating, and resolving health care fraud, waste, and abuse . The Special Investigations Investigator, Consultant will report to the SIU Manager. In this role you will represent a high level of professionalism both internally and externally. Conduct investigations in accordance w
Email Job
Posted 4 days ago
Actuarial Analyst, Experienced
Blue Shield of CA
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Oakland, CA / Long Beach, CA / El Dorado Hills, CA / 3 more...
Your Work In this role, you will Be responsible for analytic work required to convert pricing and financial goals at the line of business and region level into specific action plans at the provider level that the Network team can execute Build and update models that allow the actuarial team to quantify financial gaps and opportunities at a provider level Conduct and devel
Email Job
Posted 4 days ago
Actuarial Analyst, Principal
Blue Shield of CA
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Oakland, CA / Long Beach, CA / El Dorado Hills, CA / 3 more...
Your Work In this role, you will Be responsible for converting pricing and financial goals at the line of business and region level into specific action plans at the provider level that the Network team can execute Create value for the Growth team General Managers by ensuring they have a voice when it comes to key network decisions and network strategy Create value for th
Email Job
Posted 4 days ago
Data Analyst - Health, Experienced
Blue Shield of CA
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Long Beach, CA / Oakland, CA / El Dorado Hills, CA / 2 more...
Your Role The Network Performance Analysis and Contracts is part of the Provider Partnerships & Network Management Division and focuses on provider network performance analysis, reporting, and consulting. The Data Analyst Health, Experienced will report to the Manager, Data Analysis. In this role you will provide analytical support through the analysis and interpretation
Email Job
Posted 4 days ago
Program Manager, Principal
Blue Shield of CA
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Woodland Hills, CA / Oakland, CA / Long Beach, CA / 3 more...
Your Role The Network Management and Provider Partnerships team is responsible for supporting Enterprise led mandates and managing all Business led mandates. The Program Manager, Principal will oversee the intake, review, and impact assessment for all mandates to determine what Network Management teams may be impacted. This role will ensure appropriate representation from
Email Job
Posted 4 days ago
Supervisor, Operations
Blue Shield of CA
-
Lodi, CA
The Medicare team is responsible for servicing Medicare members including Med Supp). Total Duals / D SNP (Dual Special Need Plans. The Supervisor will report to the department Manager. In this role you will manage a team of front line representatives, focusing on coaching/engagement, Quality, Inventory Management and helping evolve member experience. Our leadership model
Email Job
Posted 4 days ago
Business Systems Analyst, Experienced
Blue Shield of CA
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Redding, CA / Oakland, CA / Long Beach, CA / 2 more...
Your Role The Claims Shared Support Services team actively engages in providing and eliciting business requirements for system enhancements, by identifying a desired future state that addresses a business problem utilizing multiple analytic methods e.g. interviewing, brainstorming, chair siding/observation, problem identification, and gap analysis. The Business Systems An
Email Job
Posted 4 days ago
Case Management - Nurse, Senior
Blue Shield of CA
-
Rancho Cordova, CA / Oakland, CA / Long Beach, CA / 3 more...
Your Role The Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members' care including clinical nurses and treating physicians . The Behavioral Health Registered Nurse Case Manager will report to th
Email Job
Posted 4 days ago
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