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Medicare Advantage Clinical Care Manager

Blue Cross Blue Shield of Massachusetts
Hingham, MA
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Ready to help us transform healthcare? Bring your true colors to blue. The ...
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Summary
About the job:
Role The Clinical Care Manger is responsible for facilitating care for members and families of members who may have rising health risks or complex healthcare needs, to promote optimal health. This position is self-directed and works independently and collaboratively to facilitate care based on the principles of care management. Facilitation is focused on assessing needs, identifying health care disparities, social determinants of health, and any barriers to care. The Clinical Care Manger will engage members in...
Location:
Hingham, MA
Job Type:
Full-Time
Permanent
Occupation:
Medical and Health Services Managers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
Licensed Independent Clinical Social Worker
Licensed Clinical Social Worker
National Committee for Quality Assurance
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
5
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Senior Claims Testing Analyst

Blue Cross Blue Shield of Massachusetts
Hingham, MA
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About the job:
Senior Claims Testing Analyst is responsible for reviewing business requirements, developing, and executing comprehensive test plans, analysis of reporting, performing claims quality review, mentoring associates and ensuring department goals are met in a high-quality manner within established time frames Key Accountabilities: - Define, develop, and implement test plans and test cases to validate new coding logic or system changes for complex business requirements - Work closely with IT on testing automation and...
Location:
Hingham, MA
Job Type:
Full-Time
Permanent
Occupation:
Software Quality Assurance Analysts and Testers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
N/A
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
4
apply
Detailed Job Information

Program Manager, Release Train Engineer

Blue Cross Blue Shield of Massachusetts
Boston, MA
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Ready to help us transform healthcare? Bring your true colors to blue. What ...
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Summary
About the job:
We Need An energetic Release Train Engineer to drive performance across multiple Scrum teams on complex initiatives that impact multiple business areas. Focused on bringing new and innovative solutions to fruition across the entire product lifecycle. This role will also play a key role in driving the next level of agile transformation for the Value Stream. Ideal candidate is comfortable in both technical deep dive conversations, as well as executive business presentations. This role is eligible for our Flex persona....
Location:
Boston, MA
Job Type:
Full-Time
Permanent
Occupation:
Information Technology Project Managers
Career Level / Education:
Associate's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
N/A
Workkeys
Applied Math
4
Graphic Literacy
5
Workplace Documents
5
apply
Detailed Job Information

Senior Director, Federal Affairs

Blue Cross Blue Shield of Massachusetts
Boston, MA
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About the job:
Position Summary: The Senior Director, Federal Government Affairs will manage BCBSMA activities to achieve effective and time-sensitive advancement of BCBSMA legislative and regulatory agenda in a coordinated and integrated fashion. Key Accountabilities: Manage BCBSMA activities to achieve effective and timely advancement of BCBSMA’s federal legislative and regulatory agenda in a coordinated fashion. Work closely with the Vice President, State and Federal Government and Regulatory Affairs and other key leaders, including...
Location:
Boston, MA
Job Type:
Full-Time
Permanent
Occupation:
Chief Executives
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
N/A
Workkeys
Applied Math
5
Graphic Literacy
5
Workplace Documents
5
apply
Detailed Job Information

Senior Information Security Engineer (R01071)

Blue Cross Blue Shield of Massachusetts
Boston, MA
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About the job:
Position Summary: Provide expertise for design and support of Security Administration on security systems and applications running in the BCBSMA environment. Responsible for planning and designing security solutions, including overall architecture, installation and upgrades, documentation, operational support, process maintenance and security/data protection. Provide guidance in the development of infrastructure requirements with business, architecture group, and solution teams. Ensure the seamless integration and...
Location:
Boston, MA
Job Type:
Full-Time
Permanent
Occupation:
Information Security Analysts
Career Level / Education:
Associate's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
Distinguished Logistics Professional
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

Data Solution Architect

Blue Cross Blue Shield Massachusetts
Boston, MA
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Summary
About the job:
we need This role is eligible for our Flex Persona. The Data Solution Architect is a staff member of Data Solutions Delivery team. This role will lead the digital transformation of operational and foundational data architecture roadmaps to build highly available, scalable, and distributed data platforms using open source frameworks to process high volume, high velocity, and wide variety of structured and unstructured data. Strong focus on defining and executing data solutions with cloud (AWS) first strategy to deliver...
Location:
Boston, MA
Job Type:
Full-Time
Permanent
Occupation:
Computer Systems Engineers/Architects
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
N/A
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
4
apply
Detailed Job Information

Sr. Audit Specialist, Data Mining

Blue Cross Blue Shield of Massachusetts
Hingham, MA
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Ready to help us transform healthcare? Bring your true colors to blue. What ...
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About the job:
We Need The Senior Audit Specialist role will review paid claims for coding accuracy in accordance to claims processing guidelines, BCBSMA Medical and Payment Policies, contract interpretations and established audit protocols. The role involves detailed claims analysis of complex issues including but not limited to; understanding the specifics of new and existing claim systems/applications, how to identify opportunities for improvements by reviewing BCBSMA Medical and Payment policies, and review appeals to support...
Location:
Hingham, MA
Job Type:
Full-Time
Permanent
Occupation:
Medical Records Specialists
Career Level / Education:
Bachelor's degree
Salary:
High Income Jobs ($80K-$99K)
Certifications / Licenses:
Certified Coding Specialist
Certified Professional Medical Auditor
Workkeys
Applied Math
4
Graphic Literacy
5
Workplace Documents
4
apply
Detailed Job Information

Senior Manager - Payment Policy and Network Coding

Blue Cross Blue Shield of Massachusetts
Located in Ohio
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Job Ref: R06868 Employer: Blue Cross Blue Shield of Massachusetts Sector: ...
Details
Summary
About the job:
Health Insurance Qualifications: Part Qualified Actuary Senior Qualified Actuary Software: Cognos Job Type: Full Time Salary and Benefits: $120,600 - $147,400 per year Remote: No Location Country: United States State/Province/County: Massachusetts - MA City: Boston Post Code: 02199 Map: ( Show on map ) Description Ready to help us transform healthcare? Bring your true colors to blue. What We Need Reporting to the Associate Director of Professional Reimbursement Strategy, the Payment Policy and Network Coding Sr. Manager...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Medical Records Specialists
Career Level / Education:
Postsecondary nondegree award
Salary:
Upper Middle Income Jobs ($50K-$79K)
Certifications / Licenses:
Certified Professional Coder
Workkeys
Applied Math
3
Graphic Literacy
4
Workplace Documents
4
apply
Detailed Job Information

Senior. Manager - Payment Policy and Network Coding

Blue Cross Blue Shield of Massachusetts
Boston, MA
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Ready to help us transform healthcare? Bring your true colors to blue. What ...
Details
Summary
About the job:
We Need Reporting to the Associate Director of Professional Reimbursement Strategy, the Payment Policy and Network Coding Sr. Manager is responsible for leading the research development, proposal, implementation, and maintenance of BCBSMA’s Corporate Payment Reimbursement Policies, Enterprise Code Repository Database, Annual & Quarterly HCPC/ICD10 code updates, Clinical Code Edit Solutions and Medical Cost Saving Goals. Core functions include acting as a clinician/clinical coder & subject matter expert (SME) for all...
Location:
Boston, MA
Job Type:
Full-Time
Permanent
Occupation:
Medical Records Specialists
Career Level / Education:
Postsecondary nondegree award
Salary:
High Income Jobs ($80K-$99K)
Certifications / Licenses:
Certified Professional Coder
Workkeys
Applied Math
3
Graphic Literacy
4
Workplace Documents
4
apply
Detailed Job Information

Senior Full Stack Engineer

Blue Cross Blue Shield of Massachusetts
Boston, MA
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Ready to help us transform healthcare? Bring your true colors to blue. What ...
Details
Summary
About the job:
We Need At BCBSMA, we have a unique opportunity to work within the Integration and Interoperability Team as a Senior Full Stack Engineer. You will set guardrails, patterns and framework for other IIT & federated API development teams to follow as well as provide needed governance and audit to make sure it is followed. You will work with stakeholders, engineers, and subject matter experts to analyze, design, build and implement API proxies, back-end services and their policies, provide developer portal access for the...
Location:
Boston, MA
Job Type:
Full-Time
Permanent
Occupation:
Software Developers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
N/A
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
4
apply
Detailed Job Information
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