Summary
 

Palmetto GBA is one of the nation’s largest providers of high-volume claims and transaction processing, contact center operations, and technical services to the federal government and other commercial customers. Our core business is providing services to CMS Medicare beneficiaries, providers, and health plans. Palmetto GBA is one of the few Medicare contractors with experience in all Medicare business segments – Medicare Part A, Medicare Part B, Durable Medical Equipment (DME), Home Health and Hospice (HHH), and Medicare Advantage (MA) Part C and Part D. This broad experience base offers CMS a contractor with unique expertise and the ability to offer customized, creative, and proven solutions to complex problems.

Description
 

Position Summary

Manages a team of analysts in the accurate and timely retrieval, compilation, and distribution of data reports routinely used by internal departments and customers to make critical business decisions.   Analysis may include medical costs and trending for senior management, clinical measures, limited underwriting, and provider and operations based analytics.  May serve as lead of senior executive committee that analyzes medical costs and trends, assist in hospital negotiations in order to achieve network discounts, or ensure return on investment and productivity goals are met for the assigned area.

This is an onsite position (5 days a week).

Sponsorship: This position is not eligible for sponsorship now or in the future. 

This position will be responsible for:

• Managing large projects

• Supervising a team of more than 20 staff members, supported by two Clinical Supervisors

• Data Analysis and Data Accuracy

• Scheduling and reviewing audits

• Working with and educating providers

• Updating the website

What You Will Do:

• Oversees activities of analysts in the assigned area. Monitors the reporting process, and maintains area specific data. Ensures reports are completed timely and correctly.

• Responds to inquiries from customers and internal areas often working together with staff to handle requests.

• Processes complex analytic requests, typically clinical in nature. Runs and analyzes reports and statistics as needed.

• Coordinates with information systems department to implement/troubleshoot data transfer to customers.

• Participates in or leads various committees and work groups.

To Qualify For This Position, You Will Need:

Required Education:

• Bachelor's in a job related field (No degree equivalency)

Required Work Experience:

• 5 Years Progressively responsible healthcare data analysis and reporting experience.

Required Skills and Abilities:

• Excellent verbal and written communication, organizational, and decision making skills.

• Excellent presentation and analytical or critical thinking skills.

• Good judgment.

• Extensive knowledge of statistical concepts.

• Ability to use complex mathematical calculations.

• Proficient spelling, grammar, and punctuation.

Required Software and Other Tools:

• Microsoft Office.

• Excellent knowledge of mainframe systems and database design.

We Prefer That You Have:

• Experience with Medicare

• Experience with QC of documents

• Project management experience

• A minimum of 2 years in a management level position

Work Environment: Typical office environment. Some travel between office buildings.

What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have access and opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

 

Our comprehensive benefits package includes:

· 401(k) retirement savings plan with company match

· Subsidized health plans and free vision coverage

· Life insurance

· Paid annual leave — the longer you work here, the more you earn

· Nine paid holidays

· On-site cafeterias and fitness centers in major locations

· Wellness programs and a healthy lifestyle premium discount

· Tuition assistance

· Service recognition

 

What to Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Management will be conducting interviews.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information.

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