Excellus BCBS

Job Description: Summary:Under the general direction of the Assigned Management and in accordance with sound and ethical procedures objectives and controls a Network Services Analyst analyzes and evaluates the composition and characteristics of Health Plan provider networks. This posi

Job Description: Summary:Under the general direction of the Assigned Management and in accordance with sound and ethical procedures objectives and controls a Network Services Analyst analyzes and evaluates the composition and characteristics of Health Plan provider networks. This posi

Job Description: Summary:The Software Engineer is responsible for working on projects that are currently being visualized or developed by our organization. This role will be involved with the Software Development Life Cycle methodology and framework directing software system validatio

Job Description: Summary:The Software Engineer is responsible for working on projects that are currently being visualized or developed by our organization. This role will be involved with the Software Development Life Cycle methodology and framework directing software system validatio

Job Description: Summary:This position supervises coordinates and is accountable for the daily work of employees who provide case management and clinical related services. The Supervisor facilitates day-to-day operations of the department such as customer requests coordination of depa

Job Description: Summary:This position supervises coordinates and is accountable for the daily work of employees who provide case management and clinical related services. The Supervisor facilitates day-to-day operations of the department such as customer requests coordination of depa

Job Description: NOTE: Based on business needs and geographic territory associated with this opening we are exclusively seeking candidates who reside in Rochester NY. Summary:The Account Sales Consultant is responsible for prospecting new sales while providing service solutions for ex

Job Description: NOTE: Based on business needs and geographic territory associated with this opening we are exclusively seeking candidates who reside in Rochester NY. Summary:The Account Sales Consultant is responsible for prospecting new sales while providing service solutions for ex

Job Description: NOTE: This position is aligned to support IT Vendor Management for our Analytics Data Technology & Digital (ADT&D) division. Summary:This role is accountable for strategically managing vendor portfolios and vendor relationships for assigned internal business organizat

Job Description: NOTE: This position is aligned to support IT Vendor Management for our Analytics Data Technology & Digital (ADT&D) division. Summary:This role is accountable for strategically managing vendor portfolios and vendor relationships for assigned internal business organizat

Job Description: Summary:This position assists the Health Plan in establishing a presence in the community through home visits and community outreach bridging the gap between members and the Clinical Operations Department. Community Connections Representatives educate members about ac

Job Description: Summary:This position assists the Health Plan in establishing a presence in the community through home visits and community outreach bridging the gap between members and the Clinical Operations Department. Community Connections Representatives educate members about ac

Job Description: Summary:Conducts case management program activities in accordance with departmental corporate NYS Department of Health (DOH) Centers for Medicaid & Medicare Services (CMS) Federal Employee Program (FEP) and National Committee for Quality Assurance (NCQA) accreditation

Job Description: Summary:Conducts case management program activities in accordance with departmental corporate NYS Department of Health (DOH) Centers for Medicaid & Medicare Services (CMS) Federal Employee Program (FEP) and National Committee for Quality Assurance (NCQA) accreditation

Job Description: Summary:This position drafts and reviews provider contract documents provides assistance and responds to internal and external inquiries of pertinent regulatory and provider contracting issues.Essential Accountabilities:Works with Corporate Counsel and others in Legal

Job Description: Summary:This position drafts and reviews provider contract documents provides assistance and responds to internal and external inquiries of pertinent regulatory and provider contracting issues.Essential Accountabilities:Works with Corporate Counsel and others in Legal

Job Description: Summary:The Document Solutions team focuses on the design and creation of correspondence and transactional statements using various software programs. The Publishing Systems Engineer operates in a business analyst/document-generation specialist role as part of the Doc

Job Description: Summary:The Document Solutions team focuses on the design and creation of correspondence and transactional statements using various software programs. The Publishing Systems Engineer operates in a business analyst/document-generation specialist role as part of the Doc

Job Description: Summary:This position supports the Utilization Management (UM) workflows by providing administrative support and customer service. This position acts as a resource for both internal and external customers through completing timely and accurate inbound and/or outbound

Job Description: Summary:This position supports the Utilization Management (UM) workflows by providing administrative support and customer service. This position acts as a resource for both internal and external customers through completing timely and accurate inbound and/or outbound

Job Description: Summary:This position is responsible for the accurate and thorough claim and clinical investigation of potential claim payment integrity issues involving all lines of business. This position investigates and remediates claim overpayments creating data and reporting an

Job Description: Summary:This position is responsible for the accurate and thorough claim and clinical investigation of potential claim payment integrity issues involving all lines of business. This position investigates and remediates claim overpayments creating data and reporting an

Job Description: Summary:This position provides support and often leads initiatives related to the Divisional Strategy and Operations. The incumbent leads various projects and workstreams to ensure effective division performance and consultation on opportunities to improve overall div

Job Description: Summary:This position provides support and often leads initiatives related to the Divisional Strategy and Operations. The incumbent leads various projects and workstreams to ensure effective division performance and consultation on opportunities to improve overall div

Job Description: Summary:This position will partner with both the business area and the technical teams to develop high quality deliverables across all phases of a project and/or complex process implementation from identifying and defining process flows and use cases through to user a

Job Description: Summary:This position will partner with both the business area and the technical teams to develop high quality deliverables across all phases of a project and/or complex process implementation from identifying and defining process flows and use cases through to user a

Job Description: Summary:The Network Strategy Planning & Delivery Lead manages crossdivisional strategic initiatives costsaving programs and enterprise planning efforts while ensuring strong coordination with senior leaders and key stakeholders across the organization. This role will

Job Description: Summary:The Network Strategy Planning & Delivery Lead manages crossdivisional strategic initiatives costsaving programs and enterprise planning efforts while ensuring strong coordination with senior leaders and key stakeholders across the organization. This role will

Job Description: Summary:The Reimbursement Plan Administrator responds to and resolves written telephone and personal inquiries from subscribers groups and providers concerning all departmental products policies and procedures in a professional and efficient manner. This position coor

Job Description: Summary:The Reimbursement Plan Administrator responds to and resolves written telephone and personal inquiries from subscribers groups and providers concerning all departmental products policies and procedures in a professional and efficient manner. This position coor

Job Description: Summary:The Community Investments and Partnerships (CIP) Regional Lead is responsible for developing recommending executing and overseeing regional CIP strategy with matrix accountability to regional executive leadership. This individual leads the collaborative select

Job Description: Summary:The Community Investments and Partnerships (CIP) Regional Lead is responsible for developing recommending executing and overseeing regional CIP strategy with matrix accountability to regional executive leadership. This individual leads the collaborative select

Job Description: Summary:This position is responsible for ensuring projects and initiatives within the portfolio meet objectives by increasing employee adoption/usage of the changes to business process systems and technology roles organizational structures and more. The Portfolio Chan

Job Description: Summary:This position is responsible for ensuring projects and initiatives within the portfolio meet objectives by increasing employee adoption/usage of the changes to business process systems and technology roles organizational structures and more. The Portfolio Chan

Job Description: Summary:The Database Administrator will provide enterprise-wide administration and production support for corporate databases. This position will be responsible for installing testing configuring monitoring performance tuning security and developing evaluation plans e

Job Description: Summary:The Database Administrator will provide enterprise-wide administration and production support for corporate databases. This position will be responsible for installing testing configuring monitoring performance tuning security and developing evaluation plans e

Job Description: Summary:This Team Leader provides oversight of a team that provides financial projections and actuarial analyses for complex projects or assignments or staff performing the design and implementation of data structures utilizing SAS software. Initiates organizes and an

Job Description: Summary:This Team Leader provides oversight of a team that provides financial projections and actuarial analyses for complex projects or assignments or staff performing the design and implementation of data structures utilizing SAS software. Initiates organizes and an

Job Description: Summary:The Payment Integrity DRG Coding & Clinical Validation Analyst position has an extensive background in acute facility-based clinical documentation and/or inpatient coding and has a high level of understanding of the current MS-DRG and APR-DRG payment systems.

Job Description: Summary:The Payment Integrity DRG Coding & Clinical Validation Analyst position has an extensive background in acute facility-based clinical documentation and/or inpatient coding and has a high level of understanding of the current MS-DRG and APR-DRG payment systems.