Come join the hardest working, not-for-profit health plan in California and help deliver our mission to ensure all Californians have access to high-quality health care at an affordable price. Blue Shield of California was founded in 1939 by a group of physicians who believed that everyone should be able to afford a visit to their doctor. More than 70 years later, Blue Shield now serves 3.3 million members, and is the first health plan in the nation to limit our annual net income to 2 percent of revenue and pledge to return the difference to our customers and the community with the board of directors' approval. We returned more than $475 million in 2011. 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. In 2012, we were named one of the World's Most Ethical Companies. Since 2005, the company has contributed more than $170 million to the Blue Shield of California Foundation, one of BusinessWeek's most generous corporate foundations.
Responsibilities:
- This position performs provider contract analysis, financial research, prepares financial forecasts, analyzes data trends and translates data into useful information.
- This position interacts with a variety of internal units as well as IPA/Medical Groups to monitor financial payments and reporting to ensure compliance with contractual requirements and governmental regulations.
- Specific areas of focus include reporting and analysis of capitation, membership, shared risk arrangements, claims, and accounting functions using SQL, VBA for Access, Excel and MS Access.
- Provides contract interpretation consultation (including complex contracts) to internal business units and external provider customers. In addition, this position has oversight responsibility for financial accruals for expenses related to retroactive capitation rate increases, shared risk settlements, provider incentives, provider claims, and other complex contract provisions.
- Responsible for the development, implementation, and maintenance of information systems (report writing and database management) associated with the collection, retrieval, accessibility, and usage of information for planning and decision making.
- Maintains internal database files and tables, and develops custom reports to meet internal and external requirements.
- Works with company representatives to evaluate software and hardware needs and may design new or modify existing databases to meet changing needs.
- Often works with other departments and their personnel to coordinate retrieval and reporting functions.
- Assignments are broad in nature and diverse in scope.
- As business needs evolve, this position will prepare technical specifications and documentation for the development of new processes and reporting mechanisms to meet company needs and improve customer service. This position addresses and/or resolves complex customer issues and builds strong relationships with customers.
- This position acts as a mentor to Associate and Intermediate Analysts for procedural guidance on all unit activities. In addition, this position acts as second level reviewer for work products prepared by Associate and Intermediate Analysts.
Education/Requirements:
- Bachelor's degree and five years of related financial experience or equivalent combination of education and experience.
- Ability to read, analyze and interpret complex provider contracts, technical procedures, and governmental regulations.
- Must have developed fully automated data analysis and reporting tools.
- Must have developed complex Access databases with high usability, tools intended for users with basic knowledge of Access.
- Must have intermediate to advanced knowledge of VBA, SQL, macros, and MS Office automation.
- Must be able to debug, modify, and enhance existing Access based databases and Excel macros.
- Ability to use computers and related software applications including the development of new applications in Excel, Access and/or SAS.
- Must have excellent development skills for automated processes including database design for data manipulation.
- Exposure to AS/400, SAS, and Business Objects, is desirable.
- Has in-depth knowledge of the functions and responsibilities of other units within the company and has knowledge of our competition.
- In-depth understanding of health care related membership, capitation, and claims processing systems.
- Can take personal responsibility to get tasks completed and effectively manages competing priorities.
- Excellent verbal and written communication skills including presentations.
- Written documents include reports, business correspondence, and procedural manuals.
- Listens actively and attentively, reflecting and asking questions as appropriate to ensure mutual understanding.
Blue Shield of California is committed to remaining a drug-free work place. All positions require a pre-employment background investigation and drug screen. Blue Shield of California is an Equal Opportunity Employer.
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