Schedule: Remote -RI, MA, CT area. Compensation: $71,700 - $107,700Jump into the new world of health insurance:At Blue Cross & Blue Shield of Rhode Island (BCBSRI), our business is healthcare. But our focus is on improving lives. Be part of a team that is large enough to make a difference but small enough to be innovative. Work in a rapidly changing field. Take a chance to be creative. Move outside the status quo. Shape new ideas with the power of a national brand behind you. Join others who know diversity is strength:We appreciate and celebrate everything that makes us unique: age, national origin, citizenship status, perspectives, experiences, physical or mental disability, military status, race, ethnicity, religion, gender, sexual orientation, gender identity and/or expression. Our diversity strengthens us as an organization and helps us better serve an increasingly diverse Rhode Island population. Why this job matters:Coordinate the operational aspects of operational services as related to accuracy and timeliness of claims transaction processing, configuration or testing. Maintain and perform processes to monitor the outsourcing service delivery. Communicate and coordinate between user areas and the outsourcing party to minimize issues and increase productivity across all areas. Participate in company-wide operational initiatives and work with users to help define process requirements to deliver the best solution. What you will do:Monitor and oversee the operational areas for outsourced and retained functions. Complete operational and technical functions, completing reviews of changes, deliverables, milestones, and solutions produced with multiple strategic outsourced vendors, and resolving any identified issues.Assist with the review of all changes made to operations processing to minimize impact to members, providers, employer groups, and BCBSRI.Assess the impact of major system migrations and updates, monitoring the progress of resolution for all system issues impacting claims timeliness and accuracy. Review root cause analysis of system issues and ensure accuracy of all impacted operations processes, interaction with associated vendors.Develop, manage, track, and monitor outsourced services as related to contract deliverables including SLA, SOW and KPI measurements.Participate in monthly Outsourced Vendor Leadership meetings and attend vendor governance meetings and maintain compliance with all developed processes. Serve as liaison between internal or external business customers. Serve as an escalation point for users when expectations are not met; identify breakdown in workflows, expedite delivery of services, implement a long-term remediation plan, and work with the user community to help streamline processes and add operational efficiencies.Research, resolve and document both technical and operational issues and serve as first level escalation point to other departments or projects in resolution of risks or issues.Maintain close working relationship with outsourced vendor delivery teams to support collaboration, integration, and coordination at all operational levels.Assist in ensuring that all claims operations processing workflows implemented meet all internal and external regulations (e.g. HIPAA, BCBSA, CMS, etc.). Assist in creating responses to any internal or external audits and, if necessary, work with the appropriate parties to resolve any negative audit findings.Participate in presentation for business objectives, project scope, and financial impacts during all phases of the project development life cycle including but not limited to EDRC, Project estimation, finance committee and Project Investment committee. Provide claims SME for projects assigned.Support organizational readiness activities through participation in development and approval of testing strategy, training, communication, and business process changes.Understanding of outsourcing and vendor oversight responsibilities and service level agreementsPerform other duties as assigned. What you need to succeed:Bachelor’s degree in business administration or a related field; or an equivalent combination of education and experience Three to five years’ Medicare claims experienceThree to five years’ experience in operations managing vendor relationshipsOne to three years’ experience in claims operationsUnderstanding of health plan operationsAbility to remain calm and professional in stressful situations with customers and vendorsAdvanced analytical skills, with the ability to interpret and synthesize complex enrollment operations configuration and benefit processingGood business acumen and political savvyKnowledge of business process improvement techniques and strategiesExcellent verbal and written communications skillsNegotiation skillsPresentation skillsDecision-making skillsGood problem-solving skillsAbility to interface with employees at all levelsAbility to effectively navigate ambiguous situations with limited direction Excellent organizational skills and ability to successfully prioritize multiple tasks Extras: Experience with Medicaid Location:BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role:Remote: onsite 0-1 days per week. Permitted to reside in the following New England States: CT, RI, MA