Health Care Service Corporation

Content Writer

• Write and lead activities associated with complex Requests for Proposals (RFPs) under strict deadlines
• Participate in resolving issues or concerns associated with the RFP process
• Coordinate assigned projects independently according to detailed customer specifications
• Assist internal departments with pricing proposals, standard program proposals and ad hoc documents supporting the sales cycle
• Support the Proposal Content Administrator in developing and maintaining proposal-ready response information and materials
• Write, edit, organize and package RFP responses in compliance with client requirements
• Support sales and account management staff with questions about products, processes and administrative policies
• Keep abreast of program, technical, product and service enhancements or changes
• Manage multiple projects simultaneously
• Communicate with Subject Matter Experts to answer client questions and accurately record information in proposals
• Interact with technical staff, executive staff and other organizational stakeholders
• Coordinate proposal kick-off meetings and ensure participants understand their roles and responsibilities
• Communicate effectively on unfamiliar topics to elicit technical and program information

Proposal Writer

Operations

• Provide operational services, assistance, and program implementation and coordination for Medicaid operational functions
• Support Utilization Management, Care Management, reporting, compliance, billing, claims, enrollment, and customer service operations
• Resolve complex and/or escalated internal or external operational questions
• Work with other organizational areas to develop, test, and implement program policies, business processes, reporting solutions, and system changes
• Ensure Texas Medicaid plan state requirements are met
• Interpret and support requirements in the Texas Medicaid and CHIP Uniform Managed Care Manual and applicable managed care contracts
• Use data and reporting to monitor operational performance, identify gaps, and support compliance
• Represent the Medicaid department at committee meetings
• Coordinate corrective actions or operational improvements

Texas Medicaid Operations Specialist

IT Support

• Manage the full lifecycle of an IT product/application family from strategic planning through tactical activities
• Specify requirements for current and future products
• Lead ideation, technical development, and launch of new products
• Establish a shared vision with business unit stakeholders
• Build consensus on priorities and product execution
• Manage an application suite of 3–5 stable, mature projects/applications per year

Senior Manager – IT Product

Analyst

• Develop reports using internal and external databases and common programming languages
• Create pricing models for network negotiations and fee schedule updates used for claims adjudication
• Implement pricing information into the PREMIER Pricer system
• Validate and research report results using original operating systems and reporting databases
• Present reports to internal and external customers
• Respond to follow-up questions

Reimbursement Analyst I

Health Coordinator

• Perform behavioral health case management according to accepted department criteria
• Consult with physicians, providers, members, and other resources
• Assess, plan, facilitate, coordinate, monitor, evaluate, and advocate health options and services
• Promote quality and cost-effective outcomes using communication and available resources
• Serve as liaison to providers, physicians, and members
• Represent the dedicated custom team’s work during client audits
• Occasionally present onsite at the Downers Grove office

Behavioral Health Case Management Coordinator

Strategy

• Assist with divisional short-term and long-term planning
• Assist leadership teams with executing the business plan, strategies, analytics, and data needs for the division and functional areas
• Work with matrixed business areas to ensure alignment with divisional strategy
• Document and conduct analysis of competitive and market information for the division
• Ensure integration of competitive and market analysis with overall strategy
• Identify tools to assess and track strategic opportunities
• Provide end-to-end report development, interfacing between internal business and technical or analytical teams
• Support a governance structure with leadership for evaluating strategic opportunities
• Identify opportunities to respond to divisional needs and opportunities while understanding overall HCSC strategy
• Interact with team members and others to identify issues, gather data, brainstorm, discuss analytic approaches, and share findings
• Maintain working knowledge of systems, databases, data-gathering techniques, and analytical interpretations

Senior Divisional Strategy Consultant

Systems Engineer

• Support enhancements and new capabilities for an existing critical business application within the Claims portfolio
• Perform systems analysis for various product initiatives
• Build a backlog of systems requirements assignable to developers
• Ensure reviews of requirements, design, and code
• Help plan SIT and UAT testing and releases
• Work closely with business analysts, business owners, QA, application architects, developers, product managers, project managers, and other team members
• Support application operations by addressing operational, production, and ad-hoc requests
• Apply current and emerging technologies to business application solutions, integrations, and data movement with distributed applications
• Create detailed designs and resolutions for operational and production incident support

Senior Systems Analyst

Customer Support

• Contact members and community partners to support healthcare initiatives and activities
• Support educational and quality campaigns
• Assist with scheduling care manager and member appointments
• Perform ongoing functions related to members' health-related social needs directly or through social service departments and community-based organizations
• Respond to member inquiries
• Support clinicians in physical and behavioral health care management with provider and member activities
• Support relationships with community partners
• Work with community-based organizations
• Contribute to the design of community health outreach programs
• Perform field-based work as required by initiatives, health campaigns, and departmental functions
• Manage low-risk members for health-related social needs, education, and basic outreach screenings, assessments, and inquiries

Government Programs Care Manager, Support Specialist II

Program Manager

• Lead Information Security's strategic vendor relationship management programs
• Lead merger and acquisition security integration programs
• Serve as liaison between Information Security, business leaders, Procurement, Legal, Enterprise Architecture, Corporate Development, and external partners
• Establish governance frameworks
• Drive strategic security partnerships with key suppliers
• Oversee security due diligence activities
• Lead post-acquisition security integration efforts
• Influence cross-functional stakeholders and provide strategic recommendations focused on risk

Principal Program Manager

Account Manager

• Partner with Account Executive on client retention, growth, and day-to-day account service
• Develop and execute client-specific, internal, and external service strategies
• Serve as primary client contact for issues, escalations, tracking, and reporting
• Develop multi-year member communication, engagement, open enrollment, and wellness strategies
• Build relationships with key client contacts, consultants, and brokers
• Lead implementation activities and coordinate internal delivery partners
• Maintain Sales & Account Management databases and facilitate client and internal reports
• Prepare account and opportunity plans, product solutions, cross-selling opportunities, annual reviews, and finalist presentations
• Act as liaison between HCSC and clients and resolve tactical issues and inquiries
• Coordinate RFI/RFP responses, internal meetings, status meetings, eligibility meetings, and implementation activities
• Track client documents, account setup, ID card sign-off, benefit booklets, billing requirements, claim and eligibility issues, report requests, and open issue logs
• Coordinate BAE access and training for employers
• Educate employees and members on BCBS products and services
• Maintain industry, healthcare reform, competitive landscape, and client-needs awareness
• Assist with staff training, mentoring, and special projects
• Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program, and other applicable policies
• Maintain confidentiality and communicate with management regarding assigned responsibilities

Strategic Account Manager II – Enterprise National Accounts

Manager

• Provide care coordination to members through telephonic and/or field-based care management
• Inform and educate members on healthcare programs addressing personal health needs
• Engage members in discussions about adherence to personal health goals
• Respond to member inquiries
• Support clinical operations with provider and member activities
• Complete telephonic and/or field-based health screenings
• Conduct comprehensive health assessments and care planning
• Visit members’ homes and/or facilities as needed for complex and specialty populations
• Present clinical issues to members and physicians
• Interface with internal staff, management, external vendors, and community resources
• Travel within the assigned territory

Government Programs Care Manager III

Business Analyst

• Lead end-to-end elicitation, analysis, documentation, validation, and management of functional and non-functional requirements
• Support large, complex, cross-functional initiatives spanning standard and complementary products
• Partner with the Business Solutions Lead, business stakeholders, product teams, architects, technology delivery teams, operations, quality assurance, and external vendors
• Translate business strategy and desired outcomes into clear, complete, and implementation-ready requirements
• Identify business, technology, data, integration, operational, and vendor dependencies
• Facilitate stakeholder alignment and requirements approval
• Maintain traceability from business objectives through solution delivery, testing, and implementation
• Support test planning, test-case development, user acceptance testing, defect resolution, and implementation readiness

• Lead end-to-end quality engineering and test service delivery across a product line
• Establish the vision, strategy, and governance necessary to ensure successful product outcomes
• Oversee all testing operations
• Direct test planning and execution
• Perform impact analysis and estimation
• Manage internal and external testing resources
• Advance automation and continuous testing capabilities
• Ensure effective test environments and data management
• Serve as the primary vendor relationship manager
• Partner with business and technology leaders to balance quality, delivery speed, and business value
• Act as the primary point of accountability for testing outcomes
• Collaborate with Product, Engineering, and Business stakeholders
• Manage vendor partnerships to ensure high-quality, efficient, and scalable delivery

Senior Manager, IT QA

• Provide care coordination to members via telephonic and/or field-based care management
• Inform and educate members on health care programs addressing their personal health needs
• Engage members in discussions regarding adherence to personal health goals
• Respond to member inquiries
• Support clinical operations with provider and member activities
• Complete member telephonic and/or field-based health screenings
• Complete comprehensive health assessments and care planning
• Visit members’ homes and/or facilities as needed to support complex and specialty populations
• Present clinical issues with members and physicians
• Interface with internal staff/management, external vendors, and community resources
• Travel within the assigned territory

• Provide care coordination to members through telephonic and/or field-based care management
• Inform and educate members on health care programs addressing personal health needs
• Engage members in discussions about adherence to personal health goals
• Respond to member inquiries
• Support clinical operations with provider and member activities
• Complete member telephonic and/or field-based health screenings
• Conduct comprehensive health assessments and care planning
• Visit members’ homes and/or facilities as needed to support complex and specialty populations
• Present clinical issues to members and physicians
• Interface with internal staff, management, external vendors, and community resources
• Travel within the assigned territory