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  • 500 Exchange Street, Providence, RI, USA ● Req #1506
    Wednesday, May 18, 2022
    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’s 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 eve ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA ● Req #1511
    Wednesday, May 18, 2022
    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’s 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 ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA ● Req #1508
    Tuesday, May 17, 2022
    JOB SUMMARY:Serve as dedicated resource to new and existing Group Medicare accounts.  Provide ongoing account management to assigned accounts ensuring client satisfaction with products and services in support of sales retention and new business efforts.  Conduct member, client, and broker education sessions including Medicare 101 sessions, to maximize the experience of doing business with BCBSRI. ESSENTIAL JOB FUNCTIONS:Serve as a dedicated, consultative resource to new and existing accounts; ma ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA ● Req #1466
    Friday, May 13, 2022
    JOB SUMMARY: Perform second pass coding audits of medical record review to assure appropriateness and accurate code assignments in accordance with Center of Medicare and Medicaid (CMS) guidelines.  Perform audits, complete reporting on a regular basis and ensure compliance with applicable coding guidelines, rules and regulations. Identify and provide training for Coders and Medical Records staff.   ESSENTIAL JOB FUNCTIONS: Coordinate, schedule, and perform audits of medical record c ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA ● Req #1503
    Friday, May 6, 2022
    JOB SUMMARY: Develop the strategy and architecture for migrating and optimizing applications and infrastructure in the cloud.  Design and support the standards and mechanisms for cloud governance. Participate in all phases of cloud design, development, and integration. Support technical requirement definition, functional specifications, design documentation, vendor selection, and vendor integration as core team member of project teams. Oversee the architecture, design, and development wo ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA ● Req #1500
    Thursday, May 5, 2022
    JOB SUMMARY: Extract and analyze clinical data to satisfy regulatory and compliance reporting, management reporting, various enterprise level projects, and helping to demonstrate value and return on investment for medical management programs. Serve as a technical resource to department staff and management, for the purposes of compiling and interpreting complex clinical data sets.  Work with management of operational areas to assist them in accumulating data from clinical systems/databases to m ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA ● Req #1501
    Thursday, May 5, 2022
    JOB SUMMARY:Assist members in navigating the health care system, ensuring access to evidenced based care. Educate, empower, and coordinate services for members to improve their health and well being. Facilitate communication between patient, provider, and health plan to ensure members receive the full benefit of integrated care.ESSENTIAL JOB FUNCTIONS:Manage members through the healthcare delivery system; assess needs in order to identify appropriate interventions. Conduct telephonic or face to ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA ● Req #1499
    Wednesday, May 4, 2022
    JOB SUMMARY: Perform front-end development of corporate internet sites.  Collaborate with internal business areas, including technical teams to develop web pages.  Post, organize, and maintain various interconnected web pages; maintain the development, integration and maintenance of content management templates.  ESSENTIAL JOB FUNCTIONS: Perform front-end development for the corporate internet and intranet site. Work on projects including web layout enhancements and website enhanc ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA ● Req #1498
    Monday, May 2, 2022
    JOB SUMMARY: Work with vendors, internal stakeholders, and information security team to support and administer security tools in accordance with internal standards and best practices. Provide off-hours support to troubleshoot and upgrade software as necessary. Participate in Computer Security Incident Response Team calls when asked. Participate in special projects as assigned and take full ownership of deliverables.   ESSENTIAL JOB FUNCTIONS: Own, manage and support a variety of Information ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA ● Req #1496
    Monday, May 2, 2022
    JOB SUMMARY:Do you want to work in a company that embraces and values the diversity of their workforce and recognizes that everyone has an opportunity for success? Would you like to be part of a team large enough to create change with the power of a national brand, but small enough to be innovative and focused on helping those around you? Make a positive impact in people's lives working with us! Serve as an advocate for Medicare members by responding to the members’ inquiries regarding benefits, ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA ● Req #1369
    Wednesday, April 27, 2022
    JOB SUMMARY: Provide superior customer service to prospective members by determining and meeting their needs, providing information, and answering their questions in order to create increased sales through the telecommunications system. Retain, generate, and increase sales by receiving inbound telephone calls and making outbound calls as scheduled. Ensure compliance in all aspects of sales activities. Complete sales support related functions as designated. Aid customers and internal staff ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA ● Req #1494
    Tuesday, April 26, 2022
    JOB SUMMARY:Work independently to identify specialty and ancillary market opportunities, evaluate product concepts, and lead key product development projects and initiatives from concept through design, launch, and implementation, with ongoing ownership to drive product optimization and engagement. Work closely with market research, sales, clinical management, actuarial, underwriting, customer advisory groups, and external partners and consultants to monitor external trends. Identify product and ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA ● Req #1488
    Tuesday, April 26, 2022
    JOB SUMMARY:  Support EVP, Chief Customer Officer in organizational management process, budget and strategic initiative portfolio. Assess current state of marketplace trends and competitive activities to identify gaps in corporate and divisional plans. Develop mitigation strategies to ensure achievement of corporate and divisional goals. Assess existing organization project portfolio; ensure projects add value to organization and contribute to the achievement of key performance indicators. Assis ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA ● Req #1490
    Thursday, April 21, 2022
    JOB SUMMARY: Collaborate with management to assist with the oversight and coordination of the research, negotiation, and resolution of member and provider complaints, grievances and appeals for all products. Investigate and resolve medical necessity appeals on all company products.  Ensure compliance with state and federal guidelines, including Centers for Medicare and Medicaid Services requirements.  Maintain all appeals documentation according to external agency requirements.  Act as a ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA ● Req #1483
    Thursday, April 21, 2022
    JOB SUMMARY:Direct and oversee the employer segment strategy, product development & management and sales enablement functions for the organization. Direct the creation and management of product across the employer market segment using data insights, market analytics, and research to create multi-year membership and financial performance models. Oversee the creation and management of product portfolios aligned with strategic objectives, market segment priorities, and business performance objectiv ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA ● Req #1493
    Wednesday, April 20, 2022
    JOB SUMMARY: Assist members in navigating the behavioral healthcare system, ensuring access to evidence-based care. Educate, empower, and coordinate services for members to improve their health and well-being. Facilitate communication between patient, provider, and health plan to ensure members receive the full benefit of integrated care.ESSENTIAL JOB FUNCTIONS:Manage members through the behavioral healthcare delivery system; assess needs in order to identify appropriate interventions.Conduct te ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA ● Req #1487
    Wednesday, April 20, 2022
    JOB SUMMARY:Analyze approved contract specifications and ensure calculated provider fee schedules, reimbursement methodology, and provider contracts are prepared for system configuration according to approved standards. Facilitate the implementation and verification of provider fee schedules. Manage pricing, reimbursement, and fee schedule projects to ensure they are completed in an accurate and timely manner. Coordinate new reimbursement methodologies with internal business areas and coordinate ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA ● Req #1485
    Monday, April 11, 2022
    Job Summary:   Extract, analyze, and translate healthcare data into clear, action-inspiring narratives that support providers in their transformation from traditional fee-for-service (volume-based care) to outcomes-oriented, value-based care. Support the organization’s analytic and data translation needs as it invests in system-wide value-based care transformation. Serve as a technical resource to department staff and management. Prepare for clear, coherent data-informed conversations direct ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA ● Req #1482
    Wednesday, April 6, 2022
    JOB SUMMARY:Assist members in navigating the health care system, ensuring access to evidenced based care.  Educate, empower, and coordinate services for members to improve their health and well being. Facilitate communication between patient, provider, and health plan to ensure members receive the full benefit of integrated care.  ESSENTIAL JOB FUNCTIONS:Manage members through the healthcare delivery system; assess needs in order to identify appropriate interventions.  Conduct telephonic or face ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA ● Req #1479
    Tuesday, April 5, 2022
    JOB SUMMARY: Under the general supervision of the Government Programs Leadership, the Director of Risk Adjustment Analytics shall provide analysis, data modeling, and business process support to the financial and clinical operations of the organization:   Subject matter expert in healthcare risk adjustment domain to analyze data and provide actionable insights Familiarity in Healthcare Quality and analytics Perform analysis and reporting activities relating to risk score calculatio ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA ● Req #1465
    Monday, March 28, 2022
    JOB SUMMARY: Independently lead the extraction and analysis of health care data for specific studies and corporate initiatives.  Lead data intensive projects and serve as a technical resource to department staff and management on technical issues; develop new analyses and reporting metrics to assist management with decision making.  Train and mentor less experienced staff.  Develop and improve automated processes to increase the efficiency and accuracy of work products.   ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA ● Req #1463
    Thursday, March 24, 2022
    JOB SUMMARY: Responsible for owning and managing the full lifecycle of employee enrollment and billing requiring management of multiple vendors contributing to effectuation of medical, dental, vision,  FSA and Cobra processes.  Accountable for communication with assigned key account contacts to intake requests, facilitate resolution and negotiate prioritization. Responsible for contract and relationship management of our online-enrollment and cobra administration vendor, with ultimate acco ... More
  • 500 Exchange Street, Providence, RI, USA ● Req #1447
    Friday, March 4, 2022
    JOB SUMMARY: Work across Employer market segments to develop internal, competitive, and industry insights that drive innovative opportunities to enhance and grow customer and business performance. Lead the design, development, and reporting of critical business performance measures across the Employer Segment’s medical product and services portfolio. Specifically, understand the market and competitive environment; correlate data from across competitor and market benchmarks to shape the busi ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA ● Req #1443
    Friday, March 4, 2022
    JOB SUMMARY:Manage daily operations of department.  Manage the development, implementation, and maintenance of departmental policies, procedures, and programs.  Ensure the delivery of case management services are aligned with industry standards, best practices, and the company’s strategy.  Monitor industry trends to ensure case management programs are innovative and designed to meet the company’s goals.ESSENTIAL JOB FUNCTIONS:Manage case management programs to ensure the delivery of services is ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA ● Req #1435
    Thursday, February 17, 2022
    JOB SUMMARY:Oversee the administration of utilization review, cost and utilization trends and medical policy. Recommend enhancements to current utilization management, payment policies, quality of care and clinical criteria based on extensive knowledge of health care delivery systems, utilization strategies, reimbursement methods and treatment protocols. Help drive delivery system transformation through value-based arrangements and clinical program innovation. Contribute to the analytic efforts ... More