Health Care Service Corporation

Consultant

• Support prospective risk adjustment programs, including ACA point-of-care and in-office assessment initiatives
• Analyze program performance and identify opportunities to improve member outcomes and operational effectiveness
• Create reports, insights, analytics, report specifications, datasets, and analyses using system reporting tools
• Interface between the business and divisional data teams to generate actionable tools and analyses
• Work with program leaders and cross-functional stakeholders to support strategic program development and execution
• Analyze complex business problems using internal and external data sources
• Identify and interpret trends and patterns in datasets
• Conduct research related to strategic initiatives
• Provide insights to support decision-making
• Build customer relationships and deepen understanding of divisional data to meet evolving business needs and advance prospective risk adjustment strategies

ACA Programs Analytics & Reporting Consultant

Security Engineer

• Lead a Cloud security engineering and operations team
• Collaborate with Solutions Engineering, Infrastructure Operations, and Infrastructure Service Management teams to design and build secure cloud infrastructure solutions and blueprints
• Lead the secure-by-design development of repeatable patterns and build-kits
• Lead lifecycle management for the technology area of responsibility
• Transition knowledge to Infrastructure Operations
• Provide Level 3 support when required
• Provide technical expertise and leadership in the formulation and execution of secure cloud architecture across the organization
• Develop processes, procedures, policies and standards for cloud and automation security services
• Design, build, and drive implementation of cloud security management tools
• Hire, mentor, and manage performance of cloud security team members

Manager – Cloud Security, CNAPP

• Leverage healthcare industry knowledge, logic, and critical thinking to support business stakeholders
• Gather requirements based on business needs or data availability
• Conduct research and provide analytical support, technical acumen, consultancy, and advisory services
• Apply analytical concepts and tools to support and enhance engagements with internal and external customers
• Handle moderately complex analytical problems using internal and external data sources to provide decision-making insights
• Execute tasks according to established guidelines and contribute to team objectives
• Design and maintain data layers, follow design standards, and document organizational use cases
• Collaborate with team members and stakeholders to gather and analyze data
• Deliver actionable insights
• Provide healthcare consulting expertise focused on data visualization, data warehousing, industry-specific data, and related datasets

Analytics Consultant

Customer Advocate

• Work on the phone in a call center approximately 90% of scheduled time according to business need
• Assist members and physicians
• Respond to telephone and written inquiries promptly, accurately, and objectively
• Conduct research

Customer Advocate II

• Provide enterprise leadership and governance of data security capabilities
• Ensure sensitive data is identified, classified, protected, and monitored across the enterprise
• Align data security practices with business objectives, regulatory requirements, and the evolving threat landscape
• Partner with Technology, Legal, Privacy, Compliance, and business leaders
• Reduce data-centric risk while enabling secure data usage at scale
• Oversee Data Loss Prevention, data classification, data security management, and data integrity controls across on-premises and cloud environments
• Oversee budgets and resource allocation supporting enterprise data security objectives
• Translate data security risk into business-relevant priorities and decisions
• Ensure data security investments align to risk reduction and regulatory obligations

Director, Data Security

• Recruit and contract with small to mid-size behavioral health providers and facilities
• Develop and negotiate contracts
• Develop and maintain relationships with providers
• Ensure strategic coverage for the assigned territory
• Educate behavioral health providers
• Provide ongoing provider service
• Assist with contracting or support services for large or complex behavioral health groups and facilities
• Oversee contract adjustments, red-line changes, fee schedules, and contract language changes
• Support Illinois and expanding national markets/presence
• Travel within assigned areas of responsibility, including rare overnight stays

Senior Network Management Consultant – Behavioral Health

Analyst

• Analyze technical eligibility information
• Perform eligibility-related data entry with high attention to detail
• Work with employees/members, providers, clients, and co-workers to resolve issues
• Use proprietary systems, various system platforms, and MS Excel/Word
• Carry out oral, written, or diagrammed instructions
• Deal with problems in varying situations and reach resolution
• Support continued process improvement in a fast-paced, customer service and production-driven environment

Technical Eligibility Analyst

• Support the provider recruitment and contracting process to ensure strategic provider coverage for the assigned territory
• Develop knowledge of products, contracting language, and negotiation skills
• Conduct small- to mid-size contract negotiations for physicians and physician groups
• Develop and maintain relationships with providers
• Support complex hospital and physician contracting activities
• Travel within the assigned territory, including overnight stays

Associate Network Management Consultant

Human Resources

• Ensure groups, benefits and eligibility information is loaded to applicable systems in a timely and accurate manner
• Ensure group/member information is available by contract effective date to support claim and customer service processes
• Draft account-specific documents for new and renewing major and/or national accounts using the Masters as a base
• Plan, design and execute assigned projects independently and in team settings

Benefits Specialist

Data Engineer

• Ensure alignment of project-specific designs with the application architecture roadmap
• Support project and/or product teams on functional and technical design activities
• Define interactions between application packages, databases, and middleware systems to optimize product functional coverage
• Act as subject matter expert for products requiring integration into the application

Senior Application Architect – Data Integration

Systems Engineer

• Oversee the strategy and planning for data and analytics platform technologies
• Oversee the delivery of data and analytics platform technologies

Senior Systems Analyst

Director

• Develop and manage contracting strategies for commercial and government networks
• Develop, negotiate, and complete reimbursement contracts
• Ensure network adequacy for commercial and government networks
• Draft reimbursement agreements and negotiate contracts for hospitals, large professional groups with special pricing, and hospital-based physicians
• Achieve competitive advantage in discounts and access through contract negotiations and relationship management
• Develop strategies and negotiate contracts for newly recognized provider categories
• Oversee analysis and reporting for reimbursement strategies and take corrective action as needed
• Resolve issues and contractual disputes
• Oversee staff, ensuring goals are met, positions are filled, training is provided, and communications are shared
• Manage budget, operational reporting, and financial reporting
• Communicate with co-workers, management, customers, and leadership
• Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies, and other applicable policies
• Maintain confidentiality of company business
• Perform special projects as required or requested
• Travel as needed, including overnight stays

Director, Provider Contracting

• Analyze technical eligibility information
• Work with employees/members, providers, clients, and co-workers, including Client Management staff
• Perform accurate data entry with high attention to detail
• Use proprietary systems and various system platforms, including MS Excel/Word
• Deal with problems in varying situations and reach resolution
• Carry out oral, written, or diagram-based instructions
• Work independently with minimal supervision
• Contribute to continued process improvement

Credentialing Coordinator

• Credential or recredential professional and facility providers applying for initial or ongoing network participation
• Ensure credentialing and recredentialing are completed in a timely and appropriate manner for presentation to the medical director and/or credentialing committee
• Ensure documentation for approved providers is current at the time of committee determination
• Conduct ongoing monitoring of providers

Account Executive

• Ensure continued and increased growth
• Negotiate renewals or sell products and services to existing customers
• Understand customer needs
• Provide customer support
• Travel, including overnight stays