Ops Business Consultant Sr

Position Description

Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more.  

At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”    

The Senior Operations Business Consultant is responsible for providing analytical support to various business areas and customers. Also acts as subject matter expert providing technical and/or business knowledge to support decision making processes. Mentors' business consultants and business analysts. Collaborates on the development of Medical Value initiatives and business intelligence platforms. Compliments Consultant responsibilities and initiative support by gathering and interpreting customer requirements, competitive information and industry standards.

Responsibilities and Qualifications

Duties and Responsibilities:

• 20% - Participate in engagements with specific business areas and customers, such as: External customers, Sales, Marketing, Quality Management, Network Management, Actuarial, Finance, Pharmacy Services, Care Management, and Operations with a focus on being a subject matter expert providing technical and business level of involvement to support information needs in the decision making process.
• 20% - Responsible for the successful delivery of the design, development and implementation of analysis and research on the cost and utilization trends relative to product, program, network, benefit design, employer group, etc. and the communication of this information to key internal and external stakeholders.
• 10% - Ensures extensive research design, comprehensive data collection and sound statistical methods are applied to the cost and utilization forecasts, corporate reporting, programs, and corporate projects.
• 10% - Ensures appropriate development of research proposals, protocols, information needs, and data analysis plans to support the analysis and assessment of internal and vendor programs involving sales initiatives, contracting, quality improvement, clinical management, cost and utilization trend analysis and benchmarking, pharmacy benefit management, medical affairs, and other Corporate initiatives.
• 10% - Mentors business areas in the initial assessments, requirements, project plans, solutions, research and selections with a focus on data, information reporting, and analysis. Lead project task execution by ensuring progress, organizing project data, and coordinating team meetings.
• 10% - Focuses on project collaboration with business areas or external customers where a proficiency in business knowledge exists.
• 10% - Provides information to customers/clients in development of engagements, materials, events, initiatives, committees, meetings and presentations by gathering needed information and using appropriate frameworks and models in the development of assessment materials.
• 10% - Provides support for other analytical and reporting needs, trend analysis, financial improvement plans, compliance and regulatory reporting coordination (NCQA, HEDIS, DOH, HHS, CMS, FEP, OPM). Individual will be responsible for performing retrospective trend analysis, business requirement gathering, customer needs assessments, documentation of data needs/source mapping, competitive and industry information.

Skills:

• Ability to drive results to completion while managing multiple projects and priorities competing for resources. Ability to compliment Principal Consultants in their responsibilities and roles.
• Experience and proficient knowledge of project management techniques. Includes experience in planning, organizing, leading and managing multiple projects concurrently.
• Ability to perform knowledge transfer to Business Consultants.
• Ability to communicate proficiently, effectively, and consistently with all levels of internal/external personnel to prepare written materials and oral presentations for technical and non-technical audiences. Includes seasoned negotiation/persuasion skills to lead meetings and ensure mutually agreeable solutions among multiple departments/Plans, as well as, successful completion of a project.
• Advanced problem-solving and structured analysis/design techniques. Includes the ability to understand complex inter-related systems and to independently resolve business and technical problems encountered.
• Ability to adapt to constantly changing priorities. Includes ability to work with minimal supervision and to inspire teamwork among diverse groups.

Knowledge:

• Experience with quality studies, population based analysis, disease management, health care financial trend analysis, modeling, and a background in research methodologies and statistics.
• Knowledge of managed care insurance and business processes, data, systems, and applications for claim payments, network and provider contract administration and management.
• Knowledge of or ability to understand and interpret NCQA, JCAHO, American Accreditation HealthCare Commissions/URAC standards, HEDIS, CMS and HHS requirements.
• Knowledge and experience in Crystal, Microsoft Access, Microsoft Excel, reporting and testing software, as well as other Microsoft Office Suite tools.

Experience:

• Minimum 5-8 years technical or operational work experience.

Education and Certifications:

• Prefer a Bachelor's Degree in one of the following; mathematics, statistics, business administration, health planning and administration, finance, economics.

Work Environment:

Working environment includes typical office conditions.

Physical Demands:

While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see. The employee must be able to work over 40 hours per week. The employee must occasionally lift and/or move up to 5 pounds.!!Sedentary work involving significant periods of sitting, talking, hearing, keying and performing repetitive motions. Work requires visual acuity to perform close inspection of written and computer generated documents as well as a PC monitor. Working environment includes typical office conditions.

Other:

• Performs other related duties and assignments as directed.
• Travel@@Travel, including overnight excursions may be required.

About Us

We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a diverse and caring team of supportive colleagues and be encouraged to volunteer in your community.  We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career.      And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.