Provide financial analysis of Cost of Health Care initiatives and programs. Incorporate into the company's broader financial planning, forecasting, pricing, and reporting processes.
Provide managed healthcare subject matter expertise by participating in, leading, or driving various company projects.
Identify utilization and payment outliers. Identify root causes and help with steps to resolution
Develop tools and processes to monitor the financial risk.
Monitors cost and utilization trends for unusual changes and communicates those findings accordingly
Interprets and communicates updates and changes to regulations and/or contract(s) and contract amendments.
Develop reports in accordance with business unit and medical management needs and run monthly production processes on an agreed upon schedule.
Ascertain insights and identify areas of concern from monthly reports.
Summarize key analytic concepts, methodologies, and results for audiences of varying level of analytic understanding.
Reconcile data results from different sources and combine them into integrated reports spanning cost, quality, utilization, and risk profile metrics.
Develop financial models; collect and evaluate data, analyze results.
Participate on internal workgroups and committees to provide analytical insight and support for the implementation and enhancement of new programs, products, and services. This may include interactions with internal and external customers to define analytical needs and specifications.
Research and respond timely and accurately to customer (internal and external) inquiries.
Other duties as assigned.
Knowledge and Experience
Typically, requires a college degree or equivalent experience and minimum 10 years of prior relevant experience.
Requires mastery level knowledge of Finance and Accounting typically obtained through advanced education combined with experience. May have deep knowledge of project management.
A minimum of 8-10 years of managed health care experience including health plan operations and regulatory requirements.
At least 10 years of experience using/querying data from healthcare transaction systems (Facets, QNXT, Diamond, etc.).
At least 5 years of experience reading, interpreting, and analyzing the data underlying provider contracts including experience with analyzing Division of Financial Responsibility documents.
Intermediate experience with specific systems key to the role (e.g., Oracle, Essbase, Microsoft SQL).
Demonstrated intermediate proficiency with Microsoft Excel (Pivot Tables, VLookups), Word, Access, and PowerPoint.
Possess the process knowledge and people skills to complete accurate assignments and communicate results.
About Company: At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. We're excited to share Blue Shield of California has received awards and recognition for - LGBT diversity, quality improvement, most influential women in corporate America, Bay Area's top companies in volunteering & giving, and one of the world's most ethical companies. Here at Blue Shield of California, we're striving to make a positive change across our industry and the communities we live in - Join us!
EEO Footer: External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.