The Claims Processing Manager is primarily responsible for ensuring that strategic and operational initiatives at the Divisional and Corporate level are achieved. In doing so, the incumbent provides direction and leadership to ensure that objectives are successfully met, efficiency is optimized, governmental and Blue Cross and Blue Shield Association mandates are followed, and business plans support customers, as well as Divisional and Corporate goals. The Claims Processing Manager directly supervises staff comprised of exempt and/or non-exempt associates to ensure the timely, accurate application of benefits and processing of claims and inquiries on behalf of all customers.

The Management Candidate Program is designed to provide a structured and engaging environment in which to learn foundational management competencies and the Performance Management (PM) philosophy of Blue Cross and Blue Shield of Alabama. The incumbent receives routine management tasks, including managing a group of associates, and special projects as assigned by manager. Examples of duties include: implementing the Performance Management process to improve efficiency in the area, providing performance and behavior related feedback and reinforcement to associates, verifying time cards and Performance Based Pay (PBP), creating aligned Performance Improvement Plan (PIP) goals and measures, conducting performance appraisals, and, when necessary, initiating appropriate disciplinary procedures with approval from upper management and/or Associate Services. Participate in and complete new managers’ training program and supplemental activities.

The Senior Risk Adjustment Analyst position is responsible for leading Business Analysts, contract management, vendor liaison, delegate oversight, writing business requirements, serving as the liaison to IT, ensuring the quality of data by leading UAT (User Acceptance Testing), analyzing, reporting, and developing recommendations on data. The Senior Risk Adjustment Analyst will utilize project management principles when undertaking projects associated with CMS Operations. The Senior Risk Adjustment Analyst shall lead projects through the project management defined phases: initiating, planning, executing, monitoring, and closing.

The Health Care Analyst position is responsible for analyzing health care data related to BCBS of AL networks, claims, utilization, precertification’s, care management activities and supporting the development and implementation of utilization management strategies. The Health Care Analyst position supports Health Management by performing analysis as it relates to healthcare utilization and quality, including analytical design, data gathering, analysis, etc. The position creates and publishes periodic reports, as well as any necessary ad hoc reports that fulfill corporate initiatives and meet the obligations to employer groups, providers, executives, and other internal customers. Presentation, communication and organizational skills are critical aspect of the position. The capability of thinking and acting independently, as well a strong analytical problem solving, is important to the success of this position.

• Responsible for identifying requirements and translating them into operational plans.• Analyze and monitor project progress and report status to project stakeholders.• Primary Point of Contact (POC) for business stakeholders, leadership and project team resources.

• Proficient in hardware, software and general application support.• Provides leadership and support to super-user groups.• Provides level II and III support for day-to-day production issues while maintaining tickets within the issue tracking system.• Works with the other IT staff, executives & upper level management on special projects as needed.• Develops and analyzes ad-hoc Crystal Reports (SQL queries).

• Responsible for major implementation activities including implementation planning, training, organizational change management, and system roll-out to 37 clinic sites• Served as liaison between CMO (Chief Medical Officer), vendors and implementation team leads• Developed and managed master implementation plan, including schedules for training and system roll-out• Assisted CMO in ensuring readiness of each site prior to go-live implementation of the PM/EMR system• Managed geographically dispersed implementation staff• Worked with EMR and LIS vendors to develop functional HL7 interface

• Created, maintained and supported custom crystal reports• Trained clients and other staff in private and live Business Objects sessions• Developed and maintained a repository of reports for client use• Developed custom reporting kit for NCQA PPC PCMH standards

• Senior member of Clinical and Business Objects skillset• Acted as Mentor/Advisor for other Support staff• Co-Presenter at annual Customer Conference• Provided onsite training during client go-lives

• Provided full customer support in a fast paced team orientated environment• Trained clients on workflow issues• Developed plans to increase the efficiency of the support department through a “Hotlist” of common issues• Enlisted for special projects including QA testing, Dictation, iPad, Business Objects, Captivate Projects with the Training Department, and assistance with the Marketing Group