Sr Medicare Enrollment Analyst

Please email hr_business_partners@bcbsri.org if you are a candidate seeking a reasonable accommodation for the application and/or interview process.

Schedule: Hybrid

Compensation: $80,100 - $120,200

Jump 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:

Monitors the daily enrollment operations by working closely with the internal operations team and the vendor. 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:

• Assist with monitoring the Medicare Enrollment area for outsourced functions, including but not limited to:

• Day to day vendor operations

• Validate enrollment processing.

• Validate completion of daily error reporting.

• Incomplete Applications

• Validate enrollment denials.

• Enrollment discrepancy validation process

• Oversight of retro enrollment and disenrollment process

• Responsible for end-to-end Group MA onboarding process.

• Assist with Senior Markets portfolio project implementation and assists with testing.

• Handle escalations on complex issues and eligibility issues.

• Serve as liaison between internal or external business customers. Identify breakdown in workflows, implement a remediation plan, and work with the user community to help streamline processes and add operational efficiencies.

• Resolve and document both technical and enrollment issues leveraging standardized governance/ technical processes and tools.

• Maintain close working relationship with outsourced vendor delivery teams to support collaboration, integration, and coordination at all operational levels.

• Assist with ongoing reviews, self-monitoring of enrollment operations processing as it relates to products and associated benefits sold to MA groups and individual members.

• Coordinate with the Manager of Medicare Operations and Lead for Outsourced Operations to assist with projects gaps

• Identify successes, improvement opportunities, and risks. Collaborate with Medicare Operations and Lead for Outsourced Operations on mitigations and process improvements.

• Perform other duties as assigned.

What you need to succeed:

• A combination of education and related work experience

• Understanding of Medicare Enrollment processes

• Understanding of health plan operations and Medicare enrollment requirements

• Understanding of outsourcing and vendor oversight responsibilities and service level agreements

• Ability to remain calm and professional in stressful situations with customers and vendors

• Advanced analytical skills, with the ability to interpret and synthesize complex enrollment operations configuration and benefit processing

• Good business acumen and political savvy

• Knowledge of business process improvement techniques and strategies

• Excellent verbal and written communications skills

• Good problem-solving skills

• Ability to effectively navigate ambiguous situations with limited direction

• Excellent organizational skills and ability to successfully prioritize multiple tasks

• Ability to handle multiple priorities/projects

The extras:

• Bachelor's Degree in Business Administration or a related field, or equivalent experience

• Five to seven years experience in operations

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:

• In-office: onsite 5 days per week

• Hybrid: onsite 2-4 days per week

• Remote: onsite 0-1 days per week*.

• -Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Florida, Georgia, Louisiana, North Carolina, Oklahoma, South Carolina, Texas, Rhode Island, Massachusetts, Connecticut and Virginia

At Blue Cross & Blue Shield of Rhode Island (BCBSRI), diversity and inclusion are central to our core values and strengthen our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity, affirmative action employer. We provide equal opportunities without regard to race, color, religion, gender, age, national origin, disability, veteran status, sexual orientation, genetic information and gender identity or expression.

The law requires an employer to post notices describing the Federal laws prohibiting job discrimination based on race, color, sex, national origin, religion, age, equal pay, disability, veteran status, sexual orientation, and genetic information and gender identity or expression. Please visit https://www.eeoc.gov/employers/eeo-law-poster to view the "EEO is the Law" poster.

Other details

• Pay Type Salary

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• Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, Rhode Island, United States of America